Theology, Hospitals and Gender Identity

The whole business about a Catholic hospital refusing a transsexual access to surgical services has been rattling around in my head for some time.

So, I decided to go see if I could find some kind of reasonably intelligible, biblically-centered argument that could have led the hospital in question to the conclusion it arrived at.

As the old saying goes, seek and ye shall find. The article itself appears to be moderately old - likely from somewhere in the early to mid-1990s. However, it serves as a fairly decent jumping off point for my analysis, as it is fairly coherent, and tries to root itself in the concepts of scripture to make the case.

Looking at the paper in its entirety, it makes several very fundamental errors of reasoning that I need to point out.

First, the author makes the claim that because there are some number of stories of transfolk who have transitioned and then backed away when they "found Jesus" that one must thusly conclude that similar paths will work in the broader population of transsexuals. This is, of course, a deeply flawed attempt at a proof by induction. Even in the world of mathematics, proof by induction is fairly difficult. When people are being described, inductive proof is virtually impossible. Come to that, it's not terribly hard to find transsexuals who are in fact Christians.

The second error of reasoning that the author makes involves making the supposition that religious conversion is equivalent to psychotherapy, or if one takes certain statements of the author's at face value, possibly even higher value than psychotherapy. First, it is arrogant to outright dismiss the value of a discipline simply because it suits one's ideological goals. Second, because the author chooses not to cite either the DSM or the HBIGDA Standards of Care, it is quite clear that he is deriving his conclusions regarding psychotherapy based on supposition regarding the treatment and management of transsexual clients. This is argument by assertion, with only limited useful evidence to back it up.

The third high level error of reasoning comes in the regular mixing of terminology. Quite routinely the author switches to the term "transvestite", using it in a manner that suggests it has an equivalence to the term "transsexual". This results in the conflation of two similar, but distinct conditions in the reader's mind and implicitly links the two topics. While a transsexual may cross-dress as part of the therapeutic process to determine if transition is the appropriate path for them, they are not transvestites - their motivations for cross-gender presentation are quite different.

The last point of logical error is the author's insistence upon driving back to arguments based on biblical sexuality. Again, had the author made a more complete study of the subject area before leaping in with both feet, he would have recognized that gender is not sex, and sex is not gender. While sexual relations are part of an intimate relationship, they are not the relationship itself, and you find again and again that the rational narratives of transsexuals often has little to do with sexuality itself.

Neither biblical exegesis nor research science gives credibility to the transsexual's insistence that he or she is the opposite sex caught in an opposite sex body.

If one were seeking absolute causal explanations, I might see where this is coming from. However, when we are discussing attributes of someone's personality, seeking absolute causality seems rather pointless indeed. One might as well ask why one person is a pathological liar while their cousin has never been known to tell a lie at all.

What is important, and both the SOC and DSM emphasize this is the persistence and durability of the feelings involved. Those who are experiencing a "passing fancy" are not good candidates for transition at all.

While the author's point that we do not know the causal origins of transsexuality are valid to a degree, it fails to recognize the persistence of feelings that so many transsexuals experience and live with prior to transition.

Jesus Christ had a physical body, Col. 2:9. Clearly, then, the body is good. Biblical anthropology knows nothing of the pagan greek dualism that pits the body against the spirit with the former being evil and the latter good Bodily concerns and health are valid human concerns.

Wait a second, here. The very assertion that we have a soul, and the claim that the soul is eternal, surviving beyond our mortal lifespans is in essence to claim that even in Christian theology there is in fact a duality between body and soul. While the question of one being good, and the other not is perhaps not part of Christian belief, gender identity is neither good nor evil. By focusing upon the physical body, the author is essentially dismissing the very core narrative that is common to most transsexuals.

As I have argued in other writings on matters of identity and sexuality, it is unreasonable to simply dismiss someone else's narrative simply because it is inconvenient. That is poor reasoning at best, and condescending argument at worst.

In fact, I would argue in counterpoint to the author's supposition that in fact the distinction that Christianity makes between "body and soul" opens the door to the possibility that in fact one's "soul" may in fact be a "feminine soul" even in a masculine body. To the best of my knowledge, scripture is quite unclear on whether the soul is "gendered" or not, but it is not unreasonable to suppose that if the soul is the seat of personality that it may well be.

Confusion about gender and gender roles became the norm. God highlighted this issue in His curse on man's rebellion.

Later, God had Moses teach:

A woman shall not wear a man's clothing, nor shall a man put on a woman's clothing, for whoever does these things is an abomination to the Lord your God.

Dev. 22:5.

Ah...once again, we fall into the trap of equating transsexualism and transvestism. If one assigns even a limited truth value to the transsexual claim of "being in the wrong body", then in fact the Male to Female (MTF) transsexual is arguably not cross-dressing when she presents in the feminine role. In order for Deuteronomy to be parsable with respect to the phenomenon of transsexuality, one must first demonstrate that the transsexual narrative is utterly invalid. While the paper's author has made the claim that such is the case, he has not by any means provided the reader with any compelling evidence to back up his claim.

(I will point out that many of the writer's claims about gender role and how it is learned rest upon some of Dr. John Money's work. While I admire Money's dedication and desire to contribute positively to our knowledge of gender identity, some of his work had tragic outcomes, and may in fact have demonstrated that his early notions that gender is primarily rooted in socialization to be troublingly false.

The fact that hermaphrodites have few, if any, problems with transsexualism, when one might expect them to have problems if any group of people would, proves that there is no physiological cause. As a group they prove that once a sex gender role have been assigned, children adjust well and experience few problems." Thus, sexual gender roles are largely learned."

Well, actually, people who are Intersex probably have fewer problems with transsexuals in general because they have experienced some of the same challenges that transsexuals experience in finding treatment to help them find their "stable place" in the world. Further, more recent perspectives on the Intersex run quite at odds to what the paper claims, with an increasing demand to allow the intersexed individual to choose their gender role later in life.

"The causative factors in transsexuality appear to be the same as those in transvestism and homosexuality. The transsexualist's mother is typically an unhappy woman, who clutches her son to her bosom - literally or figuratively - entering into an intensely close relationship with him from which the father and other children of the family are excluded".22

This is blatantly false. I have not seen any literature written since I graduated from University that substantiates such a simplistic view of the causality of either homosexuality or cross-gender identity. This is arguably a hangover view in the paper which persists today in the world of people like James Dobson because it is convenient and simple. More recent work such as True Selves are more candid and freely admit that we really do not know. What we do know is that simplistic "it's the parent's fault" explanations tend to fall apart under scrutiny.

The paper then goes on to talk about the "biblical response" to transsexualism:

This supernatural washing, setting apart, and justification are sufficient to put these sinful lifestyles in the past. My friend is evidence of this truth. Perry Desmond is a man who had two sex-reassignments. God's grace truly transforms.34 Surely it is sufficient.

As with my common critique of the "ex-Gay" claim of "healing through conversion", such experiences have limited validity when mapped onto the broader population in question. There are a handful of a small population for whom religious conversion seems to be adequate to enable them to leave their sexual or gender identity issues behind. For those individuals, one must wish them well on their life journey. However, to claim that such an approach is "universally applicable" is flawed indeed. (Just as transition is not the "right path" for every cross-gender identified person, neither is religious conversion going to "work" for everyone)

It is perhaps the attitude the author takes towards Intersex children that is most telling:

While these individuals are not the direct concern of this article, a brief word is necessary. Ethically, you should help the parents take responsibility for surgical-hormonal treatment. As much as is possible, the external genitalia should be brought into conformity with the genetic gender of the child.35

Genetic gender? Huh? What is the "Genetic Gender" for someone who is a genetic mosaic (has both XX and XY chromosome pairs in different cells)? Or, for that matter what about the XXY chromosome pattern of Klinefelter's syndrome - is that person really "genetic female" or "genetic male"? Such absolutist thinking is as dangerously flawed as John Money's hypothesis about gender as primarily a 'socially learned construct'.

You need, also, to point the transsexual to Christ. Once a transsexual is converted, medical care should be given. Since the believer must live according to God's will, he or she must resume his or her created gender.

It gets worse. While I appreciate that my doctor is entitled to his religious views, and so on, the last thing that any patient wants is a sermon when sitting in the doctor's office. I would feel very sorry for any transsexual whose doctor (or therapist) chose to follow the guidance of this paper's author indeed.

While I think I understand better the kind of reasoning that Seton Medical Center used to arrive at their decisions, but I also believe that the reasoning is based not upon sound ethics and research, but instead upon assertion, a lack of research and poor logic - resulting in intolerance of anyone who does not fall within a narrowly prescribed view of the world.