Annemarie Shrouder is a Canadian diversity and inclusion specialist. In 2008, Shrouder published a major internal review of policies at CAMH that marked the beginning of the end for the key people operating their regressive gender clinics.
Background
Shrouder earned a bachelor’s degree from University of Guelph in 1993, then attended University of Toronto, earning a bachelor’s degree and master’s degree, both in 2001. Since then, Shrouder has led diversity initiatives at a number of Ontario institutions. In 2007 Shrouder was named LGBTQ Strategy Development Coordinator at CAMH. After six months of research, Shrouder published a report critical of the way CAMH served transgender clients.
My 2007 comments
I sent this to Shrouder on November 26, 2007 and got a reply that day.
To Annemarie Shrouder:
Thanks for your efforts in addressing serious issues at the CAMH Clarke Institute. I am a longtime critic of their role in decades of institutionalized oppression of trans people, not only in Toronto, but throughout the world. Since you’ve probably been inundated with partisan viewpoints, I will keep this brief.
1. The Clarke has a “parole board” mentality common among old-guard gatekeeping facilities that controlled access to trans health services. It is nearly the last “clinic” of its kind in North America, and should be disbanded in my opinion.
2. The Clarke staff members have been worldwide leaders for decades in several problematic areas:
- Reparative therapy on children (“curing” trans children)
- An “addiction” model offering “treatment” for those unhappy with their sexualities
- Phallometrics and application of forensic psychology for gender nonconformity (dating back to Freund)
- Etiology and taxonomy for trans people based on sexual arousal (definitions based strictly on sex assigned at birth)
- Focusing on the “problem” of trans women and ignoring health needs of trans men
- Turning down the vast majority of surgical applicants when The Clarke controlled funding (over 90% rejected)
- Prohibitive requirements that drive most clients to private or extralegal healthcare options
- Selecting participants/test subjects based on those who fit their taxonomies (convenience sampling)
- Using their nonrepresentative samples to conduct and publish research
- Using academic journals to suppress and discredit criticism
- Sociobiological/eugenic underpinnings present at the Institute since its opening in 1966.
3. Below are published statements by and about people working there:
- Ray Blanchard: “A man without a penis has certain disadvantages in this world, and this is in reality what you’re creating.”
- Kenneth Zucker: “Zucker found several predictors of adolescent GID: lower IQ, lower social class, immigrant status, non-intact family, and childhood behavior problems unrelated to gender identity disorder.”
- Susan J. Bradley: (with Zucker) “a homosexual lifestyle in a basically unaccepting culture simply creates unnecessary social difficulties.”
- James Cantor: “These people are erotically attracted to the idea of being female…like a cross-dresser who wants to appear female all the way down to the bone, rather than just by the clothes.”
- Maxine Petersen, an older transitioner and Clarke collaborator: “Most gender patients lie.”
It is this atmosphere of distrust and contempt that is the root of all the problems. Everyone listed above should in my opinion be fired, which would probably take care of 90% of the problems at The Clarke.
4. In the heyday of the “gender clinic” system, patients learned the “right” responses to match pet theories of gatekeepers at each clinic. Most trans people who see the Clarke Institute favorably are older transitioners who identify as “disabled” and are frequently recipients of government assistance. Because they are rarely able to assimilate after transition and are typically low-functioning socially, their identities are validated by programs at the Clarke, where they are classified in more socially acceptable ways than they might be under other taxonomies (which described them as “pseudotranssexual” or “nontranssexual”). Many actually enjoy the rigid requirements and humiliation, which somehow validates them and even plays into their fantasies regarding feminization.
I believe the CAMH Clarke Institute’s research will be the historical equivalent to gender that the infamous “Tuskegee Study of Untreated Syphilis in the Negro Male” is to race. I am not saying this to be rhetorical or hyperbolic, either. They are really that bad.
You are welcome to use or share the contents of this letter in any way you see fit. Thanks very much for your time, and feel free to contact me if you require citations for anything above or have any questions.
Sincerely,
Andrea James
andreajames@uchicago.edu
PS: Some of my writings about CAMH Clarke list my tsroadmap.com email address as a contact, which has been closed due to spam. Please contact me via my University of Chicago email address.
Shrouder’s 2008 report
In 2008, after 6 months of gathering feedback like mine, Shrouder released a 74-page document titled “Strategy to Build Relationships and Partnerships with LGBTTTQQI* Communities.”
The following is from the Executive Summary:
In Focus Groups and individual interviews with LGBTTTQQI community members, the Gender Identity Clinic and Gender Identity Disorder Service were cited as the main concerns. Some LGBTTTQQI community members have had negative experiences due to the underlying theories, approach, and treatment at these clinics. These experiences have resulted in negative feelings and perceptions – which have impacted CAMH’s reputation in broader LGBTTTQQI communities within the GTA and beyond.
Issues raised in particular, are that the clinics have:
GIC
- Used the Medical Model (pathologized)
- A greater priority on research, relative to care
- Demonstrated a lack of willingness to engage with LGBTTTQQI communities and engage in dialogue
- Exhibited poor therapeutic communication and engagement. Some identify dismissive, condescending and authoritarian attitudes of staff
- Used a surgery-only track
- Supported and promoted the theories of Homosexual Transsexualism and Autogynephelia
- Used guidelines that are four-times (for hormones) and double (for the real
life experience) the current WPATH Standards of Care
Gender Identity Disorder Service:
- Used the Medical Model (pathologizing)
- Focused on removing cross-gender behaviour
- Demonstrated a lack of willingness to engage with LGBTTTQQI communities and engage in dialogue
- Exhibited poor therapeutic communication and engagement. Some identify dismissive, condescending and authoritarian attitudes of staff
Most of the feedback received during the writing of this strategy has been from Trans adults. Individuals who were clients at the Gender Identity Disorder Service as children or youth were not forthcoming (with one exception). One CAMH clinician speculates that sexual minority youth subjected to the GIDS approach early in life are more likely to be disenfranchised from clinical services and the LGBTTTQQI community, and are therefore unlikely to hear about and/or participate in such focus groups. 4 LGBTTTQQI communities (particularly the Trans communities) have evolved over the last few decades, as have the standards of care for treatment of Gender Identity Disorder. There is a perception among some LGBTTTQQI community members that the Gender Identity Clinic and the GIDS have not reflected the evolutions within LGBTTTQQI communities in theory and practice.
There are many examples (locally, nationally, and internationally) of treatment and care for transgender adolescents and adults that are client-centred and rooted in an informed consent approach. Similarly, there are different clinical perspectives about children who exhibit cross-gender behaviour, as evidenced by the different term – Children with Gender Variant Behaviour (rather than children who have Gender Identity Disorder). 3 Since 70%-90% of children who exhibit cross-gender behaviour later come out as Lesbian, Gay, or Bisexual, it is argued that labeling this behaviour as pathological has negative consequences to self-esteem and self-acceptance of LGBTTTQQI individuals.
Outcome
While it’s commendable that CAMH began taking active steps to overcome historical problems, it took many more years to take the drastic action needed. Zucker was fired in 2015 and the children’s clinic was closed. Many other key players were sent packing, too. Within months of the rehaul, wait times for trans health services had dropped dramatically.
References
Shrouder, Annemarie (2008). Strategy to Build Relationships and Partnerships with LGBTTTQQI* Communities. http://www.camh.net/About_CAMH/Diversity_Initiatives/final%20LGBTQ%20strategy.pdf [archive]
Shrouder, Annemarie (2008). Executive Summary. http://www.camh.net/About_CAMH/Diversity_Initiatives/final%20Exec%20summary.pdf [archive]
Resources
Annemarie Shrouder (annemarieshrouder.com)
LinkedIn (linkedin.com)
CAMH (camh.ca)