Understanding Gender Dysphoria, page 17
While gender identity is more fluid than biological sex, when we have cases in which a person experiences gender dysphoria, what is the best way to proceed? Although the body of Christ should resist rigid stereotypes of gender that might be unbearably restrictive, I also want to reiterate a cultural shift that may contribute to greater uncertainty around sex and gender.8 Toward that end, I see the value in encouraging individuals who experience gender dysphoria to resolve dysphoria in keeping with their birth sex. Where those strategies have been unsuccessful, there is potential value in managing dysphoria through the least invasive expressions (recognizing surgery as the most invasive step toward expression of one’s internal sense of identity). Given the complexities associated with these issues and the potential for many and varied presentations, pastoral sensitivity should be a priority.
Telling Others
Those I have known who experience gender dysphoria often feel remarkably alone. They may experience something they do not understand (“Am I losing my mind?”), and if they choose to share that experience, they face the extraordinary challenge of explaining it to others. I try to assure them that they are not alone in the sense that I know and will not leave them, and I will work with them on finding others who can provide support. I also assure them that they are not alone in the sense that, while this is not a common experience, they are not the only person who has experienced gender dysphoria. I do want to know who else knows about the person’s gender dysphoria, mostly because I want to develop some social support for the person as they navigate this terrain.
To help facilitate a discussion about disclosure to others, it can be helpful to provide psychoeducation on different types of constraints9 that make disclosure difficult. These constraints essentially function as obstacles to disclosing to others. There are two types of constraints: proscriptive constraints and prescriptive constraints. Proscriptive constraints regarding gender identity communicate the following: “Discussions about gender identity are not welcome here.” This message comes from individuals and communities for whom the topic is so threatening that there is no discussion to be had. This makes disclosure almost impossible for the person because the message is that the person’s gender identity conflicts are not allowed to be talked about in this relationship or community. In contrast to proscriptive constraints, prescriptive constraints communicate the following: “Discussions about gender identity can and should be discussed, but we only discuss it in this certain way.”10 This can make discussing gender identity concerns difficult because the person who is struggling initially feels welcome to disclose but then is quickly told that there is only one way for them to actually think about their gender identity.
The person navigating gender identity concerns can begin to think about relationships and communities that subtly or not-so-subtly convey one or the other constraints. When such constraints are present, it is exceedingly difficult to disclose one’s experience. Thinking through relationships and communities that reflect either of these constraints can help shorten the list of people to whom the person can disclose. Disclosure in this sense is an invitation to greater transparency and understanding of what the person has been facing.
Unfortunately, religious communities frequently struggle with coming alongside someone navigating gender identity concerns. If a person grows up in a religious community in which they received the message that a gender presentation that is not 100 percent male or 100 percent female is a sin, an abomination, this makes it all the more likely the person will keep what they are facing private and will continue to travel the road alone.
Some people who experience gender dysphoria find that telling another person is freeing because it means they are not alone in carrying that burden anymore. Others may feel incredibly anxious because they are certain that if they were to tell someone else, the other person’s response would be rather negative, such as rejection, anger or hurt.
Sometimes distinguishing “how you are” from “who you are” may be helpful when sharing experiences of gender dysphoria with another person. I find this to be especially true when an adult shares with his or her parents. Now, if a person experienced early onset, the parents typically express concern and eventually bring their child in to see a professional who makes the diagnosis if warranted. If we are discussing late onset, this can be especially challenging, as it may go against how parents have always known and seen their child. One approach with parents might be to say something like this: “I think I am experiencing what is called gender dysphoria. It’s like I have a strong sense within myself that doesn’t match my body as a man (or as a woman) and I feel like someone more in-between. Can you tell me about how I behaved as a kid?”11
This approach allows the parents to discuss their memories of the person as a child, especially their memories of the person’s gender-typical and gender-atypical behaviors. These are the parent’s memories, and not the person’s memories, but this approach may help bring parents in—to help parents invest a little more emotionally, and it shows them the person’s desire to have them join him or her in the journey.
I also tell those who experience gender dysphoria that if the person they tell reacts with anger, disbelief, rejection or hurt after they tell them about their experiences, it is not their fault. I usually reiterate that they did not choose to experience gender dysphoria; they found themselves experiencing gender dysphoria, and this is not an issue of blaming but of realizing there may be negative reactions for different reasons.
Here are a few examples:
Some religious leaders may react with anger, hurt and frustration because they are simply overwhelmed by something they do not understand or do not wish to investigate outside their religious doctrines.
Some friends, family members or religious leaders may feel that if they are in any way supportive of people with gender dysphoria they are somehow denying the gospel or the truth. That is, “if you don’t correct the sinner, you’re complicit in the sin.”
Some parents may grieve what they believe is the loss of a dream, or perhaps several dreams. Maybe it is the loss of a dream that you, their child, would be married and that you would have the chance to feel what they’ve felt as parents. They may also be grieving because they are afraid they have not done enough for you as parents and have failed you in some way.
Some grandparents may grieve the loss of what they believe is hope for a grandchild, which would fulfill their roles as grandparents.
Some friends may be frightened that you may not be the outward person they have always known or may feel like you have been lying to them and react with gossip or scolding.12
Improving Communication
I mentioned in chapter two that people in the same family who love and support one another or who may be in conflict with one another frequently draw on different explanatory frameworks. These frameworks function as lenses or ways of seeing gender dysphoria. The three frameworks we have been discussing are the integrity framework, the disability framework and the diversity framework.
The example I gave was Jazz, a male-to-female gender dysphoric pre-adolescent who adopted a cross-gender identification as female. When asked, her preferred language was a diversity framework. She shared that she thought of being transgender as “special” or “unique.” In contrast, her older sister used more of a disability framework to explain gender dysphoria to her friends: “I tell people that it’s a disorder and that it wasn’t . . . that it’s not by choice.” You could imagine yet another person in the community utilizing the integrity framework to question (from more of a religious faith perspective) whether cross-gender identification is the best option for a child.
To help improve communication, it can be useful to highlight the primary lens through which each person in the family sees the experience of gender dysphoria. Is a person seeing through a lens of diversity that speaks to identity, as Jazz was doing? Or is a person seeing through a lens of disability in order to marshal compassion from others, as Jazz’s sister was doing? Or is still another person seeing through a lens of integrity that emphasizes sacredness in a way that may be part of the very same family or faith community? If so, just identifying the lens or framework is a first step in improving how they speak to one another by first helping them listen to each other, to come to a better understanding of each person’s point of reference. Otherwise, family members and members of the same faith community will likely speak past one another.
Matters of Faith
In the study I conducted of male-to-female transgender Christians they noted conflicts with gender identity and religious identity in terms of personal faith, God and the local church.13 Interestingly, some transgender Christians shared that their gender dysphoria led to a strengthening of their personal faith; others reported a past struggle with their faith, and still others left the organized religion with which they grew up. One sixty-two-year-old participant shared the following:
Well, I’ve certainly been through the period(s?) of “Why Me, God?” And I’ve been through periods when I’d really liked to have attended worship services en femme.
I’ve refrained from doing so, so as not to be disruptive of the spirit of reverence.14
Another fifty-eight-year-old participant shared perhaps an even more painful experience: “I am walking wounded, dry bones, defeated, tired of the struggle for normalcy or acceptance.”15
For some, the challenges they faced brought them closer to God, but others reported a strained relationship with God because of their gender dysphoria. Particularly common was past conflict with the local church community or the persons and leaders who represent these organizations. One 57-year-old participant in the study noted above shared about an ongoing struggle with God:
I shall work out my salvation with fear and trembling as I am in the process of being perfected. Either way I believe that God sees me through Christ and my hope is in His righteousness not my own. The biggest problem that I have in my relationship with Him is not reaching my own self-imposed standards, his Love never changes, I restrict how much of His Love I receive. But none the less I love Him with all my heart, if he asked me to stop dressing en-femme I would for Him, but unless he changed my transgendered condition Himself I would still be the same person I am.16
It seems to me that this is ultimately an important reference point: a person’s relationship with God. As the church facilitates that relationship, a person navigating gender dysphoria will also be making important decisions about gender identity, expression and management of dysphoria. It is hard to say that there is one path or one resolution that is ultimately satisfying to everyone. All the while, a frequently asked question by those who are gender dysphoric is, “Does this mean I am going to hell?” If by this a person is referring to gender dysphoria, the answer is, “No, gender dysphoria does not separate you from God; it does not consign you to hell.”
The path forward in the context of extreme gender dysphoria is difficult to identify. The topic often pulls otherwise thoughtful people to offer simple solutions in an attempt to live into a biblical sexual ethic, and it is the simplicity that may need to be thoughtfully and gently challenged:
We can speak of the simple choice for or against God’s new creation, the simple alternative of a broad way and a narrow way, the straightforward either-or opposition of sin and virtue. We can speak of the life of the believer as one in which there is love and no sin, and of the life of the unbeliever as one in which there is sin and no love.17
O’Donovan observes that these for/against categories are in part what it means to give morality meaning, to direct us eschatologically toward the purpose found in the “new creation.”18 So, yes, there is a moral reality and one that has been revealed to us and impressed upon us and our minds and bodies. However, this can quickly lead Christians to reduce complexity to simplicity by what O’Donovan sees as a legalism to a codified and comprehensive blueprint for moral action:
[Legalism often produced in Christian ethics] attempts to ensure the simplicity of the concrete decision by making the codified law entirely comprehensive. If every eventuality can be foreseen and provided for in an elaboration of the moral code, then, when the moment of decision arrives, it is confronted in its simplest form as a choice for or against obeying God’s law. The ambiguities have been cleared out of the way by the experts, so that the moral agent, provided that he will take expert advice, need not be troubled by the tasks of discernment but has only to take the simple decision of will seriously.19
As I indicated above, if there was ever a topic that elicited simplicity in the face of remarkable complexity, it is gender dysphoria. We are witnesses to simplicity in both the direction of conservatives who mock20 those who experience gender dysphoria and attempt to resolve their dysphoria in some of the most invasive ways, as well as experts who may assume that transition to cross-gender identification is preferred with little thought given to the integrity and sacredness of sex in particular.
Concluding Thoughts
A culture at war politically and over morality and epistemology contributes to reducing complexity to simplicity, from thoughtful reflection to media sound bites. Perhaps it is a miracle anyone is actually helped or ministered to in that context.
Yet the Christian enters into this discussion with a different reference point:
The ultimate and simple decision is not found in the books of human deeds, but in the book of life, where it is a question of Yes or No: either a name is there, or it is not. But the book of life does not supplant the books of men’s deeds; rather, those books, when read in the light of that book, take on the character of a correspondingly simple and final decision, a Yes or No to God’s grace. However much our moral decisions strive for clarity, they are never unambiguous or translucent, even to ourselves. But—and is this not the gospel at the heart of evangelical ethics?—it is given to them by God’s grace in Christ to add up to a final and unambiguous Yes, a work of love which will abide for eternity.21
In one of the first exchanges I had with a male-to-female transsexual Christian who I will refer to as Sara, she opened the exchange with, “I may have sinned in the decisions I made; I’m honestly not sure that I did the right thing. At the time, I felt excruciating distress. I thought I would take my life. I can’t imagine going back. What would you have me do?”
That is a pretty disarming exchange. This is not someone who has made a commitment to a worldview and philosophy bent on deconstructing meaningful categories of sex and gender. If you had come to argue with Sara about a sexual ethic, you would not have found an opponent. She might have agreed with you, in fact. How does a person like Sara maintain a posture of repentance and a soft heart toward God in light of the impossible decisions she faced? Is there a Christian community that is willing to stand next to her in these impossible circumstances?
As a psychological condition, Gender Dysphoria is such a rare condition that we have little good research from which to draw strong conclusions. I have known people like Sara who experienced gender incongruence and a rise in the associated distress so strongly that they felt that nothing less than their sanity and their life were at stake. They desperately sought a resolution. This is not an argument that they then should pursue the most invasive procedures or cross-gender identification, but I also acknowledge that I understand and empathize with that decision, as painful as it often is.
Rather than reject the person facing such conflicts, the Christian community would do well to recognize the conflict and try to work with the person and with those who have expertise in this area to find the least invasive ways to manage the dysphoria and to offer compassion and mercy when that has not been possible. Perhaps future programs of research will provide greater insight and clarity into an area that seems particularly difficult to navigate at present. In the meantime, the Christian community can help foster growth in spiritual maturity among those who are facing impossible circumstances, as well as facilitate “a final and unambiguous Yes” to God’s mercy and grace.
7
Toward a Christian Response
At the Level of the Institution
A large Christian university in California was recently in the position to navigate the difficult terrain of gender identity concerns when a popular theology professor—Dr. Heather Ann Clements—shared his experience of coming to terms with gender identity questions he had been facing for some time. He shared that he preferred to be known as Heath Adam Ackley (or H. Adam Ackley).
According to news reports,1 Adam came to terms with his transgender identity shortly after the publication of the DSM-5, which had changed the name “Gender Identity Disorder” to “Gender Dysphoria”:
You can’t change someone’s gender by giving them psychiatric medication. If they’re born transgender, they’re always going to be transgender. . . . APA has finally realized that . . . so I was taken off all the psych meds at the beginning of this year. I was told I am sane, and that I am a guy—I’m just a transgendered guy. And that’s all I had to hear.
A few years prior to this report, Julie Nemecek (formerly John) settled a dispute with a small Christian college in Michigan following a complaint she filed with the US Equal Employment Opportunity Commission.2
More recently, a complaint was filed against a Christian university by a female-to-male transgender student who had requested on-campus male housing. News reports at the time suggested the student was offered single-room on-campus housing (or off-campus housing with males) but was denied on-campus male housing.3
I raise these examples to point out that the Christian community faces several challenges at present and will continue to face these challenges and more in the years to come surrounding gender identity, gender dysphoria and transgender issues. These examples are institutional tensions, but they also represent real people who were navigating gender identity concerns in the context of a Christian community. The Christian community and its institutions (churches, faith-based higher education, private schools, campgrounds, ministries and so on) will see more of these points of tensions in the years ahead.
