Ethics
Biases by researchers often make it difficult to study contentious issues.
In terms of gender identity and sexual orientation, beginning with a set idea of what is right and wrong can lead to inaccurate findings.
The important starting point in research is to lay down ground rules. Here is a good guide created for psychiatrists who work with LGBT clients: http://www.aglp.org/gap/8_ethics/
As we will see in the "Sissy Boy Experiment," these rules become extremely important when working with someone under the age of 18. This is explained well here:
Lesbian, gay, bisexual, and transgender (LGBT) adolescents experience disparities in mental and sexual health. There is also a lack of research on this population relative to other adolescents, which limits our ability to effectively address these health disparities. Researchers may unfortunately avoid conducting research with this population because of anticipated or actual experiences with difficulties in obtaining IRB approval. A case example is provided to illustrate the ethical and regulatory issues related to research with LGBT adolescents. Relevant U.S. federal and local regulations related to research on sexual and mental health with adolescents is then reviewed. Data are presented demonstrating that requiring parental consent for LGBT youth under age 18 would likely alter study result. Data are also presented on participants' appraisals of the risks and discomforts associated with research participation. The provision of such empirical data on the risks of research participation is consistent with the goal of moving the IRB process of risk/benefit assessment from being entirely subjective to being evidence-based. Finally, recommendations are provided on how to approach these issues in IRB applications and investigators are called to help to build a corpus of scholarship that can advance empirical knowledge in this area. (http://mail.ts-si.org/othermnuresources/29933-ethical-and-regulatory-issues-with-conducting-sexuality-research-with-lgbt-adolescents-a-call-to-action-for-a-scientifically-informed-approach)
Biases by researchers often make it difficult to study contentious issues.
In terms of gender identity and sexual orientation, beginning with a set idea of what is right and wrong can lead to inaccurate findings.
The important starting point in research is to lay down ground rules. Here is a good guide created for psychiatrists who work with LGBT clients: http://www.aglp.org/gap/8_ethics/
As we will see in the "Sissy Boy Experiment," these rules become extremely important when working with someone under the age of 18. This is explained well here:
Lesbian, gay, bisexual, and transgender (LGBT) adolescents experience disparities in mental and sexual health. There is also a lack of research on this population relative to other adolescents, which limits our ability to effectively address these health disparities. Researchers may unfortunately avoid conducting research with this population because of anticipated or actual experiences with difficulties in obtaining IRB approval. A case example is provided to illustrate the ethical and regulatory issues related to research with LGBT adolescents. Relevant U.S. federal and local regulations related to research on sexual and mental health with adolescents is then reviewed. Data are presented demonstrating that requiring parental consent for LGBT youth under age 18 would likely alter study result. Data are also presented on participants' appraisals of the risks and discomforts associated with research participation. The provision of such empirical data on the risks of research participation is consistent with the goal of moving the IRB process of risk/benefit assessment from being entirely subjective to being evidence-based. Finally, recommendations are provided on how to approach these issues in IRB applications and investigators are called to help to build a corpus of scholarship that can advance empirical knowledge in this area. (http://mail.ts-si.org/othermnuresources/29933-ethical-and-regulatory-issues-with-conducting-sexuality-research-with-lgbt-adolescents-a-call-to-action-for-a-scientifically-informed-approach)
Beneficence versus Nonmaleficence
Beneficence: Taking action to do some good.
Nonmaleficence: Taking action to avoid some harm.
These must be balanced in research and practice, but special care should be given to Nonmaleficence. We should not leave a person worse than when the research started.
Beneficence: Taking action to do some good.
Nonmaleficence: Taking action to avoid some harm.
These must be balanced in research and practice, but special care should be given to Nonmaleficence. We should not leave a person worse than when the research started.
The ‘Sissy Boy’ Experiment
CNN’s AC360 - The ‘Sissy Boy’ Experiment
Avoiding ‘Sissy Boy’ Research - Insider Advantage
It may be difficult to remain objective when doing research, which means the perfect research team would include people who identify with a population and others who do not. The following video is based on the definition of objectivity from journalism. However, the emphasis on "sources" is exactly what we do in psychology.
CNN’s AC360 - The ‘Sissy Boy’ Experiment
Avoiding ‘Sissy Boy’ Research - Insider Advantage
It may be difficult to remain objective when doing research, which means the perfect research team would include people who identify with a population and others who do not. The following video is based on the definition of objectivity from journalism. However, the emphasis on "sources" is exactly what we do in psychology.
Gender issues and the DSM-5
The DSM has a long history of handling sexuality issues poorly. This has created a situation that has made many marginalized groups vulnerable. You can read a good introduction to this topic, here: Facts About Homosexuality and Mental Health
As the above article notes, "In 1973, the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in the United States, led the Board of Directors of the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some psychiatrists who fiercely opposed their action subsequently circulated a petition calling for a vote on the issue by the Association's membership. That vote was held in 1974, and the Board's decision was ratified."
However, transgendered individuals still face "diagnosis" for who they are. The DSM-5 has even created some new problems. This is not surprising because the subworkgroup on gender and sexuality issues was not well received by the gender and sexual minority community:
Objection to DSM-V Committee Members on Gender Identity Disorders
Throughout the research into gender variance, those who experience gender incongruence have long taken offense at the terminology, methodology, and conclusions reached. Drescher’s (2010) important history into “queer diagnoses” also notes how researchers have a history of ignoring or becoming hostile to research that did not support their points of view. Given the historical tendency for theory to revolve around harmful stereotypes, it is important to move into the DSM-5 with the most objective view possible. So far, the subworkgroup responsible for addressing gender variance has done some positive things. They moved gender variance out of the sexual disorders category. They also changed the term Gender Identity Disorder to Gender Incongruence, which is the term generally used by most therapists and counselors. However, in February, they moved into less positive territory. They changed Gender Incongruence to Gender Dysphoria, as if gender variance were a necessarily negative state. They argued this would correspond better with ICD. In their rationale section, they argued that they still did not want to think of this as a "disorder," but they believed using internationally accepted language would assist with insurance claims. Though I believe this change was damaging, it is still better than the existing nosology.
The recommended change that is worse than the existing diagnosis is a post-transition specifier. The current recommendation is to label anyone who had completed transition, regardless of whether they had any current sense of "dysphoria" or incongruence as still requiring the diagnosis. They argued this was necessary because some people may start hormones but not complete the transition process and will need to have the diagnosis to assist with counseling and medication.
There are several problems with this: 1) If the individual in question has yet to satisfy the conditions for federal gender change, why call the specifier "post?" 2) Insurance companies do not generally pay for hormone treatments anyway (unless necessary for one’s legal gender), and 3) labeling someone with a permanent DSM diagnosis does exactly what the subgroup was purporting to change. I can see no benefit for this specifier, unless the individual in question has a lingering sense of gender incongruence (i.e., the hormonal or surgical change did not end the sense of incongruence).
As a woman who labeled male at birth, I am very concerned about this post-transition specifier. I see the potential of undoing much of the work from the last 20 years. Some states still do not allow people to change their birth certificate to match their gender. To be honest, the fact that I am writing this note exemplifies part of the problem. I would like to be content to live my life as a woman without needing to justify myself or my “non-diagnosis” to the psychiatric community.
If gender dysphoria has a purpose in the DSM-5 (which is a separate question to address altogether), then we need to limit the stigma to those actively displaying gender incongruence. If no gender incongruence remains, the diagnosis should be dropped from an individual’s assessment. But this was not the case. You can get a sense of where it was going by watching the below video.
The DSM has a long history of handling sexuality issues poorly. This has created a situation that has made many marginalized groups vulnerable. You can read a good introduction to this topic, here: Facts About Homosexuality and Mental Health
As the above article notes, "In 1973, the weight of empirical data, coupled with changing social norms and the development of a politically active gay community in the United States, led the Board of Directors of the American Psychiatric Association to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Some psychiatrists who fiercely opposed their action subsequently circulated a petition calling for a vote on the issue by the Association's membership. That vote was held in 1974, and the Board's decision was ratified."
However, transgendered individuals still face "diagnosis" for who they are. The DSM-5 has even created some new problems. This is not surprising because the subworkgroup on gender and sexuality issues was not well received by the gender and sexual minority community:
Objection to DSM-V Committee Members on Gender Identity Disorders
Throughout the research into gender variance, those who experience gender incongruence have long taken offense at the terminology, methodology, and conclusions reached. Drescher’s (2010) important history into “queer diagnoses” also notes how researchers have a history of ignoring or becoming hostile to research that did not support their points of view. Given the historical tendency for theory to revolve around harmful stereotypes, it is important to move into the DSM-5 with the most objective view possible. So far, the subworkgroup responsible for addressing gender variance has done some positive things. They moved gender variance out of the sexual disorders category. They also changed the term Gender Identity Disorder to Gender Incongruence, which is the term generally used by most therapists and counselors. However, in February, they moved into less positive territory. They changed Gender Incongruence to Gender Dysphoria, as if gender variance were a necessarily negative state. They argued this would correspond better with ICD. In their rationale section, they argued that they still did not want to think of this as a "disorder," but they believed using internationally accepted language would assist with insurance claims. Though I believe this change was damaging, it is still better than the existing nosology.
The recommended change that is worse than the existing diagnosis is a post-transition specifier. The current recommendation is to label anyone who had completed transition, regardless of whether they had any current sense of "dysphoria" or incongruence as still requiring the diagnosis. They argued this was necessary because some people may start hormones but not complete the transition process and will need to have the diagnosis to assist with counseling and medication.
There are several problems with this: 1) If the individual in question has yet to satisfy the conditions for federal gender change, why call the specifier "post?" 2) Insurance companies do not generally pay for hormone treatments anyway (unless necessary for one’s legal gender), and 3) labeling someone with a permanent DSM diagnosis does exactly what the subgroup was purporting to change. I can see no benefit for this specifier, unless the individual in question has a lingering sense of gender incongruence (i.e., the hormonal or surgical change did not end the sense of incongruence).
As a woman who labeled male at birth, I am very concerned about this post-transition specifier. I see the potential of undoing much of the work from the last 20 years. Some states still do not allow people to change their birth certificate to match their gender. To be honest, the fact that I am writing this note exemplifies part of the problem. I would like to be content to live my life as a woman without needing to justify myself or my “non-diagnosis” to the psychiatric community.
If gender dysphoria has a purpose in the DSM-5 (which is a separate question to address altogether), then we need to limit the stigma to those actively displaying gender incongruence. If no gender incongruence remains, the diagnosis should be dropped from an individual’s assessment. But this was not the case. You can get a sense of where it was going by watching the below video.
Qualitative v Quantitative
Qualitative research is good at constructing knowledge through case studies and continually returning to the data.
Quantitative research is good is discovering knowledge that may be generalized from large-scale samples.
Genetics Research. This has been notoriously difficult to study. Here is a good example of what research looks like for LGBT genetics work:
Evolutionary Anthropological Research (the interdisciplinary study of the evolution of human physiology and human behaviour and the relation between hominids and non-hominid primates. Evolutionary anthropology is based in natural science and social science)
Types of Quantitative Research
The below video is very long, but please watch the first 20 minutes. It displays the importance of how LGBT individuals face enormous financial, employment, and social struggles. It also provides the importance of quantitative and qualitative research.
The first speaker refers to The National Transgender Discrimination Survey [NTDS]. We will discuss this more when we get to discrimination. The second speaker discusses the importance of qualitative research on policy decisions.
Qualitative research is good at constructing knowledge through case studies and continually returning to the data.
Quantitative research is good is discovering knowledge that may be generalized from large-scale samples.
Genetics Research. This has been notoriously difficult to study. Here is a good example of what research looks like for LGBT genetics work:
Evolutionary Anthropological Research (the interdisciplinary study of the evolution of human physiology and human behaviour and the relation between hominids and non-hominid primates. Evolutionary anthropology is based in natural science and social science)
Types of Quantitative Research
- Experimental (powerful but limited generalizability)
- Surveys (largest numbers of participants)
- Questionnaires (formal surveys, better science, but harder to obtain)
- Experimental qualitative research (generate meaning)
- Critical qualitative research (interrogate meaning)
- Interviews and focus groups (rich data but smaller numbers)
- Naturalistic data (observational research)
- Discourse analysis (analysis of textual data); e.g., Elizabeth’s study on gay and disabled youth.
- Participatory research (make the participants the experts)
The below video is very long, but please watch the first 20 minutes. It displays the importance of how LGBT individuals face enormous financial, employment, and social struggles. It also provides the importance of quantitative and qualitative research.
The first speaker refers to The National Transgender Discrimination Survey [NTDS]. We will discuss this more when we get to discrimination. The second speaker discusses the importance of qualitative research on policy decisions.
Recruitment and Access
How do we decide who is gay?
How do we keep other factors from confounding the data (like age, education, income levels, prostitution, drug use, etc.)?
How do we decide who is gay?
How do we keep other factors from confounding the data (like age, education, income levels, prostitution, drug use, etc.)?
Research and Reorientation
Every major mental health association in the United States has a statement condemning attempts to change someone’s sexual orientation. However, the research on this topic is still questionable.
Does Reorientation Work?
Maccio, E. (2011).
Researchers disagree on whether sexual reorientation (i.e., conversion or reparative) therapy (SRT) can change sexual orientation.
Participants from a particular religious denomination or from SRT organizations.
In this cross-sectional study, 37 former SRT participants reported no statistically significant differences in sexual orientation and sexual identity from before SRT participation to the time of their participation in this study.
Practitioners with clients struggling with their sexual orientation or identity must be informed of SRT alternatives, including person-centered and gay-affirmative approaches.
Every major mental health association in the United States has a statement condemning attempts to change someone’s sexual orientation. However, the research on this topic is still questionable.
Does Reorientation Work?
Maccio, E. (2011).
Researchers disagree on whether sexual reorientation (i.e., conversion or reparative) therapy (SRT) can change sexual orientation.
Participants from a particular religious denomination or from SRT organizations.
In this cross-sectional study, 37 former SRT participants reported no statistically significant differences in sexual orientation and sexual identity from before SRT participation to the time of their participation in this study.
Practitioners with clients struggling with their sexual orientation or identity must be informed of SRT alternatives, including person-centered and gay-affirmative approaches.
What makes good or bad research?
One of the most important elements of research is being able to support your claims. Here is a good example of how not knowing the data makes you look like your position is unfounded and biased.
One of the most important elements of research is being able to support your claims. Here is a good example of how not knowing the data makes you look like your position is unfounded and biased.
Discussion Question
Find an article published within the last year. Critique it using the techniques explored in this chapter.
Be sure to use APA format throughout this class. You can learn how to do this here. http://owl.english.purdue.edu/owl/resource/560/01/
In the next video, I will walk you though how to use PsychInfo to help with this project. Also, to make the documents in the reference section "hanging indented," you may do this simply by hitting CTRL-T. (That is the control and T buttons on a PC). Do make a document double spaced, just hit CTRL-2.
Find an article published within the last year. Critique it using the techniques explored in this chapter.
Be sure to use APA format throughout this class. You can learn how to do this here. http://owl.english.purdue.edu/owl/resource/560/01/
In the next video, I will walk you though how to use PsychInfo to help with this project. Also, to make the documents in the reference section "hanging indented," you may do this simply by hitting CTRL-T. (That is the control and T buttons on a PC). Do make a document double spaced, just hit CTRL-2.