The Vanity Fair article on Bruce Jenner’s gender transition into Caitlyn Jenner has created a lot of buzz. Given the dominant perspective on sexual diversity in North American culture, much of the public response has been enthusiastically affirmative. Meanwhile, Christians are trying to figure out what to make of the stories of people with gender dysphoria. How are we to understand this theologically and to assess it morally?
A Christian perspective on gender dysphoria from Mark Yarhouse
In Christianity Today, Mark Yarhouse (identified as “the leading Christian scholar on gender dysphoria”) discusses the phenomenon of gender dysphoria and our response to it. He describes “three cultural lenses through which people tend to see” it, and outlines his own perspective. (Readers wishing more than they will get from Yarhouse’s magazine article may want to obtain Yarhouse’s new book [due from IVP on June 22] Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture [Christian Association for Psychological Studies Books].)
On account of the inclusion of transgender with lesbian, gay, and bisexual, in LGBT, people commonly confuse the transgender phenomenon with the other three, but Yarhouse helpfully distinguishes them, and this is critical in framing our approach to and assessment of the condition of people experiencing gender dysphoria. As Yarhouse wisely observes, “Gender dysphoria and transgender issues are not about having sex or attraction to the same sex; they are about an experiential mismatch between one’s psychology and one’s biology.”
Yarhouse defines “gender identity” as “simply how people experience themselves as male or female, including how masculine or feminine they feel,” whereas “’gender dysphoria’ refers to deep and abiding discomfort over the incongruence between one’s biological sex and one’s psychological and emotional experience of gender.”
Yarhouse identifies three types of Christian response to gender dysphoria, depending on the lens through which a person views the phenomenon.
Lens # 1. The integrity lens
. . . views sex and gender and, therefore, gender identity in terms of what theologian Robert Gagnon refers to as “the sacred integrity of maleness or femaleness stamped on one’s body.” Cross-gender identification is a concern because it threatens to dishonor the creational order of male and female.
. . . The theological foundation of the integrity lens raises the same kind of concerns about cross-gender identification as it raises about homosexuality. . . . When extended to transsexuality and cross-gender identification, the theological concerns rest in what Gagnon calls the “denial of the integrity of one’s own sex and an overt attempt at marring the sacred image of maleness or femaleness formed by God.”
. . . people who see through the integrity lens are concerned that cross-gender identification moves against the integrity of one’s biological sex—an essential aspect of personhood.
It should be noted that some Christians do not put gender dysphoria in the same category as homosexuality.
Lens # 2. Disability
. . . views gender dysphoria as a result of living in a fallen world, but not a direct result of moral choice. Whether we accept brain-sex theory or another account of the origins of the phenomenon, if the various aspects of sex and gender are not aligning, then it’s one more human experience that is “not the way it’s supposed to be,” to borrow a phrase from theologian Cornelius Plantinga Jr.
. . . The person may have choices to make in response to the condition, and those choices have moral and ethical dimensions. But the person is not culpable for having the condition as such.
. . . This lens leads to the question: How should we respond to a condition with reference to the goodness of Creation, the reality of the Fall, and the hope of restoration?
Those drawn to the disability lens may value the sacredness of male and female differences; this is implied in calling gender dysphoria a disability. But the disability lens also makes room for supportive care and interventions that allow for cross-gender identification in a way the integrity lens does not.
Lens # 3. Diversity
. . . sees the reality of transgender persons as something to be celebrated, honored, or revered. Our society is rapidly moving in this direction.
Whereas the biological distinction between male and female is considered unchangeable, some wish to recast sex as just as socially constructed as gender.
. . . What is perhaps most compelling about this lens is that it answers questions about identity—“Who am I?”—and community—“Of which community am I a part?” It answers the desire for persons with gender dysphoria to be accepted and to find purpose in their lives.
Yarhouse himself finds strength in all three lenses, so he sees “value in a disability lens that sees gender dysphoria as a reflection of a fallen world in which the condition itself is not a moral choice.” This helps him to “see the person facing gender identity confusion with empathy and compassion,” as he helps them to manage their gender dysphoria.
But Yarhouse thinks that “we should also let the integrity lens inform our pastoral care,” because this “represents a genuine concern for the integrity of sex and gender, and the ways in which maleness and femaleness help us understand the nature of the church and even the gospel.”
The third lens, “diversity,” enables us to affirm the person “by providing an identity not addressed by the other two lenses. The diversity lens emphasizes the importance of belonging. We must remember that the transgender and broader LGBT community are attractive because they answer the bedrock question, ‘Where do I belong?’ Most churches want to be a community where people suffering from any ‘dysphoria’ will feel they belong, for the church is, after all, a community of broken people saved by grace.
When it comes to support, many evangelical communities may be tempted to respond to transgender persons by shouting “Integrity!” The integrity lens is important, but simply urging persons with gender dysphoria to act in accordance with their biological sex and ignore their extreme discomfort won’t constitute pastoral care or a meaningful cultural witness.
The disability lens may lead us to shout, “Compassion!” and the diversity lens may lead us to shout “Celebrate!” But both of these lenses suggest that the creational goodness of maleness and femaleness can be discarded—or that no meaning is to be found in the marks of our suffering.
Most centrally, the Christian community is a witness to the message of redemption. We are witnesses to redemption through Jesus’ presence in our lives. Redemption is not found by measuring how well a person’s gender identity aligns with their biological sex, but by drawing them to the person and work of Jesus Christ, and to the power of the Holy Spirit to transform us into his image.
A medical perspective on gender dysphoria from Paul McHugh
Paul McHugh, MD, is University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and the former psychiatrist in chief at Johns Hopkins Hospital. He has been studying people who claimed to be transgender for 40 years, and he observes that, “Over the last ten or fifteen years, this phenomenon has increased in prevalence, seemingly exponentially.” Publicity from early examples “promoted the idea that one’s biological sex is a choice, leading to widespread cultural acceptance of the concept. And, that idea, quickly accepted in the 1980s, has since run through the American public like a revelation or “meme” affecting much of our thought about sex.”
The champions of this meme, encouraged by their alliance with the broader LGBT movement, claim that whether you are a man or a woman, a boy or a girl, is more of a disposition or feeling about yourself than a fact of nature. And, much like any other feeling, it can change at any time, and for all sorts of reasons.
McHugh reports a very important conclusion reached at Johns Hopkins:
At Johns Hopkins, after pioneering sex-change surgery, we demonstrated that the practice brought no important benefits. As a result, we stopped offering that form of treatment in the 1970s. Our efforts, though, had little influence on the emergence of this new idea about sex, or upon the expansion of the number of “transgendered” among young and old.
McHugh has not met or examined Jenner, but his behavior resembles that of some of the males they have studied at John Hopkins who have clamed to be transgender.
These men wanted to display themselves in sexy ways, wearing provocative female garb. More often than not, while claiming to be a woman in a man’s body, they declared themselves to be “lesbians” (attracted to other women). The photograph of the posed, corseted, breast-boosted Bruce Jenner (a man in his mid-sixties, but flaunting himself as if a “pin-up” girl in her twenties or thirties) on the cover of Vanity Fair suggests that he may fit the behavioral mold that Ray Blanchard has dubbed an expression of “autogynephilia”—from gynephilia (attracted to women) and auto (in the form of oneself).
But McHugh draws a very apt analogy between the meme that our sex is a feeling (not a biological fact) and Hans Christian Andersen’s tale of the emperor’s new clothes.
I am ever trying to be the boy among the bystanders who points to what’s real. I do so not only because truth matters, but also because overlooked amid the hoopla—enhanced now by Bruce Jenner’s celebrity and Annie Leibovitz’s photography—stand many victims. Think, for example, of the parents whom no one—not doctors, schools, nor even churches—will help to rescue their children from these strange notions of being transgendered and the problematic lives these notions herald. These youngsters now far outnumber the Bruce Jenner type of transgender. Although they may be encouraged by his public reception, these children generally come to their ideas about their sex not through erotic interests but through a variety of youthful psychosocial conflicts and concerns.
The idea concerning sexual identity which dominates now in our culture is “nakedly false,” in McHugh’s judgment.
Transgendered men do not become women, nor do transgendered women become men. All (including Bruce Jenner) become feminized men or masculinized women, counterfeits or impersonators of the sex with which they “identify.” In that lies their problematic future.
In Sweden, where the culture strongly supports the transgendered, an extensive study done for over 30 years followed up on “sex-reassigned people” and discovered “lifelong mental unrest.”
Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers.
McHugh is convinced that:
Plenty of evidence demonstrates that with [Jenner] and most others, transgendering is a psychological rather than a biological matter.
In fact, gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it. With youngsters, this is best done in family therapy.
The widespread idea that sex is fluid and open to choice “is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges.” But McHugh warns those who try to counter this faulty and dangerous idea that they should be prepared for trouble. “Hell hath no fury like a vested interest masquerading as a moral principle.”
The tragic story of David Reimer
David Peter Reimer was named Bruce when he was born in Winnipeg, Manitoba, and he committed suicide when he was 38, after a very troubled life. When he and his twin brother were 6 months of age (in 1966), they were diagnosed with phimosis and they were referred for circumcision as a form of treatment. Tragically, Bruce’s circumcision went very badly and his penis was “burned beyond surgical repair” by the use of cauterization. (I learned of Reimer’s experience from the newspaper when I was living in Manitoba, but I have drawn details for my report on his experience from the article in Wikipedia which accords with what I had read previously.)
Concerned for Bruce’s future happiness as a male without a sexually functional penis, his parents took him to Johns Hopkins Hospital to see John Money, “a psychologist who was developing a reputation as a pioneer in the field of sexual development and gender identity, based on his work with intersex patients.” Money was then propounding the idea which McHugh now recognizes to be dangerously prevalent, the theory of gender neutrality, which proposed that gender identity developed through social learning and that it could therefore be changed through interventions in that regard. Along with the team at Johns Hopkins, Money convinced the Reimers that sex reassignment surgery was best for Bruce and they authorized him to do it. Afterwards, Money met with Bruce about once a year for a decade to give him psychological support and he reported periodically that the transition had been successful. Sadly, Bruce’s parents are reported to have “routinely lied to lab staff about the success of the procedure,” but Bruce himself found the process traumatic rather than therapeutic.
Eventually, Bruce told his story and John Colapinto published it first in an article in Rolling Stone magazine (Dec. 1997) and later in a book, As Nature Made Him: The Boy Who Was Raised as a Girl.
Colapinto described how—contrary to Money’s reports—when living as Brenda, Reimer did not identify as a girl. He was ostracized and bullied by peers, and neither frilly dresses (which he was forced to wear during frigid Winnipeg winters) nor female hormones made him feel female. By the age of 13, Reimer was experiencing suicidal depression, and he told his parents he would take his own life if they made him see John Money again. In 1980, Reimer’s parents told him the truth about his gender reassignment, following advice from Reimer’s endocrinologist and psychiatrist. At 14, having been informed of his past by his father, Reimer decided to assume a male gender identity, calling himself David. By 1987, Reimer had undergone treatment to reverse the reassignment. (Wikipedia)
In 1990, Reimer was married and became stepfather to 3 children, but his life continued to be difficult in a variety of ways. His twin brother Brian (who had suffered with schizophrenia) died after an overdose of antidepressants in 2002, his wife requested a separation in 2004, and soon afterward David Reimer took his own life.
A theological proposal
The subjects of gender identity and gender dysphoria are areas in which theology and science necessarily intersect and our understanding of both needs to be correct or we can create problems. In these areas, I am always keenly aware of my scientific ignorance so I tread lightly and I speak tentatively where science must inform our understanding. But even theologically, some of this is relatively uncharted territory, or at least not many of us have sought and/or found a chart because we are dealing with issues which are relatively new in the long development of Christian theology. That being said, here are a few points from my theological anthropology with which I am navigating right now.
- Our sexual identity as either male or female is part of the original, good creative act of God
There is a long-standing tendency in the Eastern theological tradition which affirms not only that God transcends sexual distinctions but that we do too in ideal humanity, so sexual polarity was related to fallen rather than original creation (Paul Jewett, Who We Are: Our Dignity as Human. A Neo-Evangelical Theology, 132). We encounter this in Nicolas Berdyaev’s The Destiny of Man, so that “original sin is associated with the fall of the androgyne, that is, the division into two sexes” (Jewett, Who We Are, 132, with reference to Berdyaev, pp. 61-67). Asceticism in the eastern tradition is, in part, a moral attempt to counter this. But it is obvious to most theologians of the western tradition, among whom Jewett and I belong, that this is not the teaching of the biblical narrative (cf. Gen 1:26,27; 5:2). Just what exactly the nature of this difference between males and females is remains a mystery, but it is not something which we should deny or regret, it is a part of the very essence of our humanity. We are created human as male and female, and each of us is either male or female, by God’s choice. This was true of the first humans, and it is true of all of us. Our sexual identity is not something that we choose; nor is it simply a social construct. Paraphrasing Karl Barth, Paul Jewett puts our situation nicely: “All is in order so long as, and only so long as, we are fully conscious of our sex and thankful for it, living our lives before God as a man or a woman with a sober and good conscience” (Jewett, Who We Are, 132, citing Barth, Church Dogmatics, III/4, pp. 156ff.). As either male or female, we are equally God’s image bearers, so that, even though God transcends sexual distinctions, there must be some sense in which he includes their essential features within his own being.
Emil Brunner assumed that this sexual differentiation would pass away in the life to come, based on Matt. 12:25, and I often hear this view expressed, but the Lord did not say that when the dead rise they would be neither male nor female. Augustine rightly noticed that Jesus’ statement actually implies continued sexual difference for it is such that is assumed in “marrying” and “being given in marriage” (City of God, 22.17; cited by Jewett, Who We Are, 134). The fact is that we really do not know anything about the sex of angels, but Scripture is clear about the human situation.
When I think or talk about the phenomena of same-sex desire and of gender dysphoria I do so with a strong sense of compassion for the people who have these experiences. Precisely because being either male or female is so fundamental a part of our human personhood, any disruption of God’s good creation in this area affects us at the core of our being. So we need to feel the pain of people in this situation whenever we talk about (or to) them and their situation. This is particularly true when their current feelings and struggles are the result of factors, or of actions by others, over which they had no personal control. Such is the case especially when sexual abuse has had traumatic effects upon people and on their perceptions of sex and of their own sexuality.
- Femaleness or maleness is a fundamental aspect of both our body and our soul
Largely through the input of J. P. Moreland and Scott Rae, I have adopted a Thomistic (rather than a Cartesian) understanding of the substance duality of human composition. “According to Thomistic dualism the soul is an individuated essence that makes the body a human body and that diffuses, informs, animates, develops, unifies and grounds the biological functions of its body” (Moreland and Rae, Body and Soul, 202). I particularly like the suggestion that “in some ways the soul is to the body like God is to space—it is fully ‘present’ at each point. The soul occupies the body, but it is not spatially located within it, just as God occupies space but is not spatially located within it” (Body and Soul, 202). In this perspective, “the human person is identical to its soul, and the soul comes into existence at the point of conception ” (Body and Soul, 205). Thus, “the various biological operations of the body have their roots in the internal structure of the soul, which forms a body to facilitate those operations,” and the soul is what it is by God’s conception, intention and design (Body and Soul, 206).
I expect that you can see why, from within this understanding, I propose that maleness or femaleness of human beings is an aspect of the soul, that is, of the human person. Normally, the person conceived as a female soul will develop, during the physical maturation process, with a female body. But here is where life in a fallen world gets messy. Things in creation are no longer “normal,” in the sense of the goodness which pertained to everything as God made it originally, including Adam and Eve (Gen 1:31). By the time Adam and Eve had their first child, the effects of sin were already at work in their bodies, just as they were in the whole of physical creation which is now “subjected to futility,” and which now groans as it awaits the time when it will be “set free from its bondage to corruption and obtain the freedom of the glory of the children of God” (Rom 8:20-21 ESV). We too, as people “who have the firstfruits of the Spirit, groan inwardly as we wait eagerly for adoption as sons, the redemption of our bodies” (Rom 8:23 ESV). Hence my third proposition:
- As a result of the effects of the original (and originating) human sin, in all of creation, it seems that the body formed under direction of a female/male soul does not develop normally, so that, in some instances, it is difficult to discern from the infant’s body whether this is a girl or a boy.
As Cornelius Plantinga Jr. put it in the title of his brilliant book on sin, the situation is Not the Way It’s Supposed to Be. With the developments in DNA research we now know that some people inherit a tendency toward the development of cancer, diabetes, alcoholism, or other physical illnesses. I am hypothesizing that, analogously, in the physical development of a human being it is possible that something may go very seriously wrong so that, although a person’s soul is female or male, abnormalities occur in the development of the person’s body so that doctors find it extremely difficult to say whether the person who has just been born is female or male. This relatively rare situation is described and analyzed at length on the web site of the Mayo Clinic, in an article entitled “Diseases and Conditions: Ambiguous Genitalia.”
This phenomenon is discussed in a book published by Eerdmans very recently: Megan K. DeFranza, Sex Difference in Christian Theology: Male, Female, and Intersex in the Image of God. I know about this important book only what I learned from an author guest post by DeFranza, posted at the Eerdmans blog (EerdWord), entitled “Bridge Building in a War Zone: Sex Difference in Christian Theology.” She posits “that there are people whose bodies are not clearly or fully male or female, and that we find their presence in the Bible and Christian history but that most Christians today don’t know they exist and most churches have no place for them.” I first became aware of this reality through reading I did when the story of David Reimer first aroused my thinking in this area.
Echoing the perspective I summarized above from Paul McHugh, DeFranza writes:
Most intersex surgeries are not medically necessary. Many are performed to help the child appear less ambiguous in the hope that parents will be better able to bond with their infants and so that children can avoid other potentially difficult societal interactions (e.g., in locker rooms or at urinals).
Despite the good intentions of parents and doctors, many intersex persons recount harrowing stories of surgeries gone badly, of sex assignments rejected, and of medical treatment experienced as sexual abuse. Thankfully, as these stories are being told, change is beginning to come to medical standards of care.
These are people who may grow up in a situation somewhat analogous to that of David Reimer, even though the origin of their situation is different. Reimer struggled because he was dressed as a girl and socialized that way, without knowing until he was 15 years old that he was a boy. He had a male soul but was expected to behave as a female, and the disjunction was a terrible experience for him, leading him to further surgery to restore him as far as possible to his physical maleness, so that he could live with a body that matched the sex of his soul. In the case of the infants whom DeFranza has described, however, the genitalia were ambiguous and doctors had to judge whether the infant should be treated as male or female. I know from other reading that this often does not go well, and in adulthood some of these individuals go through (further) surgery to give themselves a body and a sexual identity which matches the sexual identity of the person they deeply feel themselves to be. Given my hypothesis with regard to the possibility of soul/body disjunction in rare cases, I consider it quite possible that these are people experiencing precisely what I have hypothesized in this point of my essay.
It is essential that we differentiate this situation from the transgender transformation of someone like Bruce Jenner. As analyzed by both Yarhouse and McHugh, Jenner’s case is clearly not one of these cases of sexual ambiguity. It is an instance of “gender dysphoria,” which Yarhouse defined as “discomfort over the incongruence between one’s biological sex and one’s psychological and emotional experience of gender.” I concur with both Yarhouse and McHugh, and against the increasingly common understanding in our society, that it is a terrible mistake to assume that sexual identity is a social construct and that one can choose whether they want to be male or female. This way leads to havoc. In the making of human souls (which I understand in the traducian way, as happening through the reproductive process, not by direct divine creation), God has determined whether each person will be male or female. Our goal should be to live as God has created us, not to decide that we will become other than we were created to be.
The gender dysphoria that would arise in the cases I am now considering, where a female soul is in an hypothesized or surgically constructed male body (or vice versa), should be seen through the second of Yarhouse’s lenses. We are dealing with a disability. But this is not an incongruence between one’s biological sex and one’s emotional experience of gender; it is, rather, an incongruence between the sex of their soul and the sex of their body. The difference between these two phenomena is extremely important.
I am among those to whom Yarhouse referred, a Christian who does not put gender dysphoria in the same category as homosexuality. I consider it quite unfortunate that T (transgender) has been lumped together with LGB in the socio-political effort to promote maximal sexual diversity. That being said, however, I think that my proposal here might be relevant to the situation of some people who experience same-sex desire. I consider it possible that there might be some instances in which people feel what they (and others) interpret as same-sex desire which is, in fact, at the core level of the sexuality of the soul/person, a heterosexual desire. Might there be some who live with an incongruence between the sex of their soul and the sex of their body, so that desire that is actually consistent with the sex of their soul (which is hidden from us and, to some extent, even from them) is necessarily interpreted only in terms of the sex of their body? I realize that I may have opened Pandora’s box here, allowing for a whole new theological excuse for, or legitimation of, same-sex desire. But we ought not to avoid considering theological possibilities simply because they make even more complex a highly disputed area of thought, and means of assessing the likelihood of this situation having occurred could be developed.
Summing up: what have we gained?
This is a very complex subject and it is one which has been studied with great expertise by authors cited in this post. I do not bring to the subject any of the sort of medical research or experience that these other people have. But I have wanted to do two things in particular:
1) I want to re-enforce the position taken by others I have cited above, that the myth of gender preference, and the idea that sexual identity is a social construct, is a very serious mistake which often produces havoc in people’s lives. (Witness the experience of David Reimer as a case in point, but also many other instances in which parents are misconstruing and responding unhelpfully to the imaginative play of young children.) When we encounter people with gender dysphoria, we need to be aware that the causes of this feeling of incongruence can be quite diverse, and it matters greatly what those causes are, when we are deciding how we as Christian individuals or as a church regard both people’s struggles and the decisions they make about how to deal with their struggles.
2) I offer a theological proposal which I hope others may find helpful as a construct for understanding the gender dysphoria of at least some people who have that painful experience. I am suggesting that in some of these cases (some instances of ambiguous genitalia), we have a disability consequent upon the effects of sin within creation. A conflict is created within a person by a disjunction between the sexual identity God gave them in their soul and the sexual identity which was assigned to them by decision of doctors and parents who acted in what they believed to be the best interests of the individual, but where their well-intentioned judgment was incorrect. Quite tentatively, I also put on the table the possibility that personal (body-soul) sexual incongruence may be a factor in situations of same-sex desire.
I realize that I am moving with this essay-length post into an area that is very highly charged emotionally, socially, and politically, but I welcome conversation from anyone wanting to carry it on with me in a mutually-respectful and Christ-like spirit.