DOCTOR’S FORWARD
These are just photographs of children. The children may look different from most others; they might cause one to wonder “what” they are and how they might be classified; they might be an affront to those who would force people to play by preset rules. But when we look closer—at our own lenses and then at the photos themselves—we see that the true worth of these photographs is the undeniable demonstration that the children portrayed here are like every other child on earth: playful, beautiful, contemplative, strong. And if we keep our own assumptions and predispositions in mind, we might recognize that these children are vivid glimpses into ways to be whole and complete—regardless of their challenges to our expectations of gender.
Increasingly, our culture has grown more tolerant of people who embrace what they know to be true about their own sexual orientation and gender identity. Those truths rarely conform to binary, polar designations. In the pages that follow, Lindsay Morris shows that there is so much more complexity, so many subtler shades, than the traditional dualistic perspective on gender suggests. Even physicians who treat transgender youth often impose their own either-or perspective, dismissing gender-fluid adolescents—those young people who are willing to live without a defined M or F identity—as “not transgender enough”. Perhaps we clinicians suffer from a lack of experience with a patient group we hardly ever see, since they rarely seek hormonal treatment. We need to see and respect gender variance in its totality. This book and its photos show a group of unique younger children benefiting from a special camp that does this, in large part by not singling them out as special.
As an endocrinologist at Boston Children’s Hospital, I have had the good fortune to work with gender-variant children for many years. In 2007, we opened the first North American medical clinic for the treatment of transgender adolescents set in an academic medical center. Our work draws heavily on techniques first piloted in the Netherlands, which were based on research from that country dating back to the beginning of this century.
A lot has changed in that short time. By 2007, awareness of transgender people and the push to present them (including adolescents and young adults) in a positive light was given a boost by numerous segments in respected media, such as ABC’s 20/20 with Barbara Walters; The Oprah Winfrey Show and The Ellen Show, and print articles in, among others, The Atlantic, The Economist, Time, The New York Times, The Boston Globe, The Times (London), as well as in regional magazines, such as Denver’s 5280.
Despite this rising awareness and appreciation of genderfluid people, we still read and hear about abuse, violence, self-harm and even legalized discrimination. And so Morris’s work makes us wonder: Are these open expressions of gender variance only possible in the secluded sort of environment such as Camp You Are You can provide? Perhaps her photos of preadolescents provide a window for kids who, later in life, will call themselves “gender fluid” or “gender queer”— kids who will see themselves in a stable or a potentially changing position along the spectrum between male and female. Or maybe they are simply photos of kids who are being given permission to self-express—a permission that is vital for any child, at any stage, regardless of the possible (and as yet undetermined) implications for who they might be later in life.
After all, it is normal for prepubertal children to experiment with gender roles, such as trying on mother’s or sister’s clothing, or dipping into the fantasy clothing box in preschool or grade school. Most kids (80 percent) who persist in such behaviors during their prepubertal years, even those who state that they wish to be in the opposite sex, will not, by the beginning of puberty, wish to change their sex. It is impossible to predict how a young person who experiments with gender fluidity will evolve, much as it is impossible to predict how any child will evolve.
But one thing is certain: We see myriad examples of children in all sorts of circumstances thriving when they are nurtured in supportive environments like the one Camp You Are You provides. In 2014, a team in Holland, studying their first group of patients who, as adolescents, had begun participating in the pubertal-suppression cross-sex steroid treatment they had piloted, evaluated their subjects for psychosocial well-being at age 20–22. The results were remarkable: Not only were the patients functioning extremely well, but their psychosocial functioning exceeded that of an age- and sex-matched control group. Like the children at Camp You Are You, their needs were being met and, as a result, they were thriving.
Their needs are being met from many directions. More and more parents and communities are supporting their children. Popular culture has followed suit. In the medical field, an increasing number of professional communities are learning to better support children who are gender nonconforming or gender queer. In 2007, Boston Children’s Hospital was the only major pediatric medical center in North America with an interdisciplinary program for gender-nonconforming youth. Now, in 2014, there are thirty-seven programs, including every province in Canada, and the numbers are growing.
I hope Morris’ photos lead us to ask how we collectively might embrace more such children more of the time. I hope we wonder more pointedly how many of them are unable to express themselves fully when away from camp; how many are bullied for not conforming to conventions; how many are at risk for self-harm. Can we embrace them as the whole, vital and worthy human beings they are? Can camp act as a sort of seed bank to sow more communities that provide, in the very same ways camp does, the safety, acceptance and celebration that ought to be the norm for every single child everywhere? These photographs are a crucial step in that crucial direction.
–NORMAN SPACK
NORMAN SPACK, MD, is a senior associate in the Endrocrine Division at Children’s Hospital, Boston, and associate clinical professor of pediatrics at Harvard Medical School. A 1965 graduate of Williams College, he received his MD from the University of Rochester in 1969. Dr. Spack co-founded the first community-based private practice of adolescent medicine in New England. He was clinical director of Boston Children’s Hospital Endocrine Division from 1998-2006. An internationally recognized advocate for transgendered individuals, Dr. Spack has received numerous awards for his teaching, clinical care, and community service. He has been selected repeatedly as one of the “Top Doctors” in greater Boston by Boston magazine. In 2007, he co-founded the Children’s Hospital’s GeMS (Gender Management Service), an interdisciplinary clinical program for transgender and intersex patients.