Things are somewhat tumultuous at Toronto’s Centre for Addiction and Mental Health at the moment. The hospital, which bills itself as “the largest mental health and addiction research facility in Canada,” made news on December 15 when it announced it would be “winding down” its Child Youth and Family Gender Identity Clinic (GIC) in the wake of an external review that had been commissioned about that clinic’s practices, with the hope of later reopening it with input from a range of community voices. The GIC’s head, the leading sex researcher Dr. Kenneth Zucker, was fired that same day. Dr. Kwame McKenzie, the hospital’s medical director of Underserved Populations division and one of the public faces of the clinic’s decision, apologized to the public that day and went on the radio the next day to reiterate and explain that apology further, pointing to the external review’s findings as evidence the GIC was out of step with current best practices.
It was a loaded, important apology. The GIC, which had for decades treated children and adolescents with gender dysphoria — that is, those who feel their biological body doesn’t match their gender identity — was both a leading research institution and a source of heated controversy. The clinic shied away from quickly transitioning children with persistent gender dysphoria to what they stated was their real gender, as is increasingly common, instead preferring, as former clinicians there put it to me, to first help children feel comfortable in their own bodies. Though the GIC focused on gender identity rather than sexual orientation, many activists and some clinicians insisted that what went on there was “conversion” or “reparative” therapy directly comparable to damaging, discredited practices aimed at “fixing” gay people. (An upcoming Science of Us feature story will dive deeply into this controversy and explain, in depth, the views of the clinic’s critics and defenders, as well as what parents of former patients think of the shutdown.)
Because the GIC was so reviled in a segment of the LGBT community, its closure was met with widespread celebration. That has been the dominant story line so far in public coverage of the event, but some current employees at CAMH see things very, very differently. They’re not happy with their employer and are wondering aloud whether their own departments, should they come under political pressure from outside forces, might be next. According to the handful of current staffers I’ve spoken with, there’s a widespread sense that CAMH bowed to political pressure, and that the external review the hospital used as its public justification for the shuttering of the clinic was an unfair, inadequately executed investigation.
On this second point, critics of the decision appear to be at least partially correct: Last week Science of Us reported that the most inflammatory allegation in the document, that Zucker had called an adolescent trans man a “hairy little vermin,” was false — the accuser acknowledged in an interview that he had gotten mixed up, and that it wasn’t Zucker or anyone at his clinic who had made the offensive comment. Two days later, CAMH pulled the review off its website, replacing it with a “summary” of the document’s findings in which the “vermin” remark isn’t mentioned.
On Thursday, the day after the article came out, CAMH held an already-scheduled meeting to assuage staffers’ concerns, led by Dr. Rani Srivastava, the hospital’s chief of Nursing and Professional Practice. Srivastava’s responses to staffers’ questions, while intended for a private audience, offer some interesting hints about how the hospital’s administrators might respond to growing evidence that the review process was less than rigorous, and to the fact that for a month and a half the CAMH website hosted a hospital-approved document leveling a false accusation against one of its biggest names.
Two staffers who attended — let’s call them “Jane” and “Dan” since they didn’t want their real names or any identifying details about them to be revealed — told me that the meeting drew a group of about 25 to 30 CAMH employees. Those in attendance had many questions but were particularly interested in learning more about the process of the GIC’s closing and Zucker’s dismissal, as well as whether and how the report was vetted prior to its publication.
According to Jane, Srivastava was rather open about the fact that CAMH had already been leaning toward shutting down the clinic anyway. She said that “what [Srivastava] shared with us was that the report influenced their decision, but it was fundamentally an affirmation of what they were already thinking. So they already had in mind to close this program, I think, and I think the report allowed them the pretense or the justification to do it.”
As for questions about fact-checking, both attendees told me that Srivastava indicated that CAMH had not seen it as its responsibility to ensure the accuracy of the document. “Her stance was that this was supposed to be an external review, and it wouldn’t be proper for CAMH to interfere with the review and tell them what conclusions to draw and get nitpicking in their process,” said Dan. “She said the hospital took no steps to confirm what was in the report,” said Jane. Rather, Srivastava told the attendees “that it was the responsibility of the reviewers, that it was a completely independent process[.]” Dan said that this didn’t go over well, and that “staff were upset that it didn’t appear CAMH [felt it] had any responsibly to fact-check.” (Over the weekend, I sent emails with questions about the statements made during the meeting to a CAMH spokesperson, as well as to Srivastava, McKenzie, and the co-authors of the review, Dr. Suzanne Zinck and Dr. Antonio Pignatiello. None replied.)
In addition, Srivastava made a noteworthy claim about Zucker’s dismissal. “She was also frank about Ken’s firing,” said Jane. “I didn’t think she was actually going to answer this question, but one of the folks at the meeting asked why Ken had to be fired — why then?” Srivastava responded that “he was fired without cause and that his firing was entirely coincidental to the release of the report. And we all sort of burst into laughter because it is so unlikely or so impossible to think that these things are the most horrible and unfortunate coincidence ever.” Dan said, “It seemed like there was much shaking of heads and other body language to suggest people didn’t find that believable.”
Overall, Dan said December’s events had led to something of a sense of paranoia among some CAMH staffers. “[M]any psychologists said, not necessarily in the meeting, but in discussions, ‘If they can fire Ken Zucker, they can fire anybody.’” The firing of such a big name has led to what he said was plummeting morale. “All of this has made staff much more concerned and wary — ‘What if the work that I’m doing becomes unpopular with some group?’” he said. “‘Is CAMH going to throw me under the bus, so to speak?’ I think the take-home message is, for staff … if groups complain about your clinic and work and are unhappy with it, your employer does not have your back.”
Science of Us’s longer story on all of this is coming soon. In the meantime, if you work at CAMH, were a patient or a parent of a patient at the GIC, or otherwise have something you’d like to share about this controversy, please get in touch.