Understanding Gender Dysphoria, page 20
Notes
Chapter 1: Gender Identity, Gender Dysphoria and Appreciating Complexity
1I first recounted this story in Mark A. Yarhouse and Erica S. N. Tan, Sexuality and Sex Therapy: A Comprehensive Christian Appraisal (Downers Grove, IL: InterVarsity Press Academic, 2014), pp. 318-19. The extended account is from Christine Jorgensen’s autobiography, Christine Jorgensen: A Personal Autobiography (San Francisco: Cleis Press, 1967).
2American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Publishing, 2013), pp. 451-59.
3Throughout this book I will cite research on Gender Dysphoria and what used to be referred to as Gender Identity Disorder. So as not to confuse the reader, I will use “Gender Dysphoria” for consistency and flow, even in cases in which I am referring to a study that used “Gender Identity Disorder.” These are not identical diagnoses, as the criteria changed in 2013 with the publication of DSM-5. If it is important to make the distinction, I will reference the diagnostic terms used at the time of the study.
4The original report presented Jazz at age six, among other gender dysphoric youth (https://www.youtube.com/watch?v=YfqmEYC_rMI). Walters provided an update on Jazz at age eleven: https://www.youtube.com/watch?v=bJw3s85EcxM.
5Stanton L. Jones, “Is Sex or Gender a Choice?,” in forthcoming Holman Worldview Study Bible.
6Other terms sometimes used for intersex conditions include “ambiguous genitalia,” “disorders of sex development,” and “male and female pseudohermaphroditism.” Tom Mazur, Melissa Colsman and David E. Sandberg, “Intersex: Definition, Examples, Gender Stability and the Case Against Merging with Transsexualism,” in Principles of Transgender Medicine and Surgery, ed. Randi Ettner, Stan Monstrey and A. Evan Eyler (New York: Hayworth Press, 2007), p. 236.
7Turner Syndrome is another genetic disorder of gonadal differentiation that “is the consequence of a chromosomal genetic abnormality in females characterized by a missing or partially deleted X chromosome.” Ibid., p. 241.
8True hermaphroditism is defined “by the presence of both testicular and ovarian tissue in the same individual” and is “associated with a number of chromosomal patterns: 46XX (most common), combined 46XX/46XY chimerism, or 46XY (rare).” Ibid., p. 242.
9American Psychiatric Association, Diagnostic and Statistical Manual, pp. 452-53.
10This term may be new to some readers. As defined here, cisgender (or just cis) references persons who are essentially not transgender or gender nonconforming. It comes from the contrast of trans (or “on the other side of”—think of taking a transatlantic flight from New York to London) with cis (which means “on this side of”) (www.oxforddictionaries.com/us/definition/american_english/cis-). The view that there is a “system of oppression” with reference to cisgender persons is referred to by proponents as cisgenderism, a “system of oppression that privileges cisgender identities and experiences over TGNC [transgender and gender nonconforming] identities and experiences, or perpetuates prejudicial attitudes and discriminatory behaviors that result in ignoring, denigrating or stigmatizing TGNC people or any forms of behavior or gender expression that lie outside of the traditional gender binary.” American Psychological Association’s proposed Guidelines for Psychological Practice with Transgender and Gender Non-Conforming Clients, p. 5; temporarily posted at http://www.apa.org, retrieved May 27, 2014. Similarly, advocates of this view, which is steeped in queer theory and draws heavily on Michel Foucault and Judith Butler, argue that “cissexual privilege refers to the rights and social abilities of people whose gender identity matches their birth gender, many of which go unseen and unexamined.” Kelby Harrison, Sexual Deceit: The Ethics of Passing (Lanham, MD: Lexington Books, 2013), p. 12.
11In a consensus statement on the management of intersex conditions, Peter Lee and colleagues discuss five major domains:
(1) gender assignment must be avoided before expert evaluation in newborns; (2) evaluation and long-term management must be performed at a center with an experienced multidisciplinary team; (3) all individuals should receive a gender assignment; (4) open communication with patients and families is essential, and participation in decision-making is encouraged; and (5) patient and family concerns should be respected and addressed in strict confidence.
Peter A. Lee, Christopher P. Houk, S. Faisal Ahmed and Ieuan A. Hughes, “Consensus Statement on Management of Intersex Disorders,” Pediatrics 118, no. 2 (2006); updated online at http://pediatrics.aappublications.org/content/118/2/e488.full.html.
12David Kinnaman, of the Barna Group, is quoted in this online article: “America’s Change of Mind on Same-Sex Marriage and LGBTQ Rights,” Barna Group, July 13, 2013, https://www.barna.org/component/content/article/36-homepage-main-promo/618-barna-update-04-25-2013#.U48VuS_gWB4.
13Ibid.
14Jones, “Is Sex or Gender a Choice?”
15Mark A. Yarhouse and Trista L. Carr, “MtF Transgender Christians’ Experiences: A Qualitative Study,” Journal of LGBT Issues in Counseling 6, no. 1 (2012): 26.
16See Trista L. Carr and Mark A. Yarhouse, “God and the Transgender Person,” in Gender Identity: Disorders, Developmental Perspectives and Social Implications (New York: Nova Science Publishers, in press).
Chapter 2: A Christian Perspective on Gender Dysphoria
1Milton J. Erickson, Introducing Christian Doctrine, 2nd ed. (Grand Rapids: Baker Books, 2001), p. 68.
2Ibid., p. 75.
3Judson Poling, “What Does the Bible Say About Gender?” meeting at Willow Creek Church, South Barrington, Illinois, February 22, 2014.
4For example, some theologians have treated transsexuality as an “extension of the issue of homosexuality.” Robert A. J. Gagnon, “Transsexuality and Ordination” (2007): www.robgagnon.net/articles/TranssexualityOrdination.pdf.
5Complex questions also arise if a person transitions from, say, male to female and enters into a relationship with a man who is now attracted to her as a woman. As one colleague with expertise in this area observed, from the referent of birth sex, this is homosexual behavior. From the referent of gender identity, this will be heterosexual behavior as experienced by the male-to-female transgender person.
6One female-to-male transgender Christian who reviewed this book manuscript shared that having a diagnosis can add another layer of complication, as the diagnosis supports the legitimacy of the problem, which is important. But reducing gender dysphoria to a diagnosis left this person feeling trapped, as there seemed to be no spiritual solution.
7However, it has been noted that the “soft men” referred to in 1 Corinthians 6:9 were thought to have feminized “themselves in appearance and matter to attract male sex partners.” Gagnon, “Transsexuality and Ordination,” p. 5.
8Evangelical Alliance Policy Commission [EAPC], Transsexuality: A Report of the Evangelical Alliance Policy Commission (Reading, UK: Cox & Wyman, 2000), p. 45.
9Ibid., p. 46.
10Ibid.
11Ibid., p. 47.
12Ibid.
13Ibid.
14Adrian Thatcher, God, Sex and Gender: An Introduction (West Sussex, UK: Wiley-Blackwell, 2011), p. 147.
15Poling, “What Does the Bible Say About Gender?” p. 2.
16Thatcher, God, Sex and Gender, p. 148.
17Ibid.
18In discussing the cultural context of the Ancient Israelites or, for that matter, the first-century church, I am not suggesting that there is too much hermeneutical distance between the first century and the twenty-first century, nor that the recorded history has no relevance for Christians today. I am concerned that just such a mistake is made by some authors who have attempted to develop exegetical models that work far too hard to move the reader away from the plain reading of Scripture.
19Heather Looy and Hessel Bouma III, “The Nature of Gender: Gender Identity in Persons Who Are Intersexed or Transgendered,” Journal of Psychology and Theology 33, no. 3 (2005), 166-78.
20Ibid., p. 176.
21Stanton L. Jones, “Sexuality,” in Baker Encyclopedia of Psychology and Counseling, D. G. Benner and P. C. Hill (Grand Rapids: Baker, 1999), p. 1107.
22Ibid.
23Ibid.
24Ibid., pp. 1107-13.
25Poling, “What Does the Bible Say About Gender?” p. 2.
26Madhur Ingalhalikur, “Sex Differences in the Structural Connectome of the Human Brain,” Proceedings of the National Academy of the Sciences 11, no. 2 (2013): www.pnas.org/content/early/2013/11/27/1316909110.
27Looy and Bouma, “The Nature of Gender,” p. 174.
28Ibid., p. 174.
29Christopher Chenault Roberts, Creation and Covenant: The Significance of Sexual Difference in the Moral Theology of Marriage (New York: T & T Clark, 2007), p. 225.
30Ibid., p. 226.
31Heather Looy, “Male and Female God Created Them: The Challenge of Intersexuality,” Journal of Psychology and Christianity 21, no. 1 (2002): 17.
32Tom Mazur, Melissa Colsman and David E. Sandberg, “Intersex: Definition, Examples, Gender Stability and the Case Against Merging with Transsexualism,” in Principles of Transgender Medicine and Surgery, ed. Randi Ettner, Stan Monstrey and A. Evan Eyler (New York: Hayworth Press, 2007), p. 242.
33Stanton L. Jones, “Is Sex or Gender a Choice?,” in forthcoming Holman Worldview Study Bible.
34Ibid.
35See http://eve-tushnet.blogspot.com/2010_06_01_archive.html#1921445070183139.
36See Mark A. Yarhouse, Understanding Sexual Identity: A Resource for Youth Ministry (Grand Rapids: Zondervan, 2013), pp. 27-28.
37Oliver O’Donovan, Resurrection and Moral Order: An Outline for Evangelical Ethics, 2nd ed. (Grand Rapids: Eerdmans, 1994), p. 19.
38Looy and Bouma, “The Nature of Gender,” p. 166.
39For a discussion of the purposes of sexuality, such as procreative, unitive and instructive, see Mark A. Yarhouse and Erica S. N. Tan, Sexuality and Sex Therapy: A Comprehensive Christian Appraisal (Downers Grove, IL: IVP Academic, 2014), pp. 34-36.
40Richard Mouw, Uncommon Decency: Christian Civility in an Uncivil World (Downers Grove, IL: InterVarsity Press, 2010). Drawing upon Martin Marty, Richard Mouw discusses the importance of Christians displaying convicted civility. His concern is that there are too many Christians who are strong on expressing convictions but weak on displaying civility. Likewise, there are too many Christians who are remarkably civil, yet others know very little about what they believe or hold convictions about.
41O’Donovan, Resurrection and Moral Order, p. 52.
42Poling, “What Does the Bible Say About Gender?” p. 5.
43O’Donovan, Resurrection and Moral Order, p. 70.
44Ibid., p. 5.
45Roberts, Creation and Covenant, p. 7.
46Ibid., p. 8.
47Ibid. Beth Felker Jones offers a thoughtful reflection on the resurrection of the body as relevant to the gospel. She argues that the “bodily resurrection is not peripheral to the Christian gospel. In fact, it is determinative of any theological attempt to rightly conceive not only human bodies as created, but also human persons as redeemed.” Later she writes, “Our bodies now must refer to the resurrection bodies to come. The doctrine of the bodily resurrection points us to a way of conceiving our whole selves, body and soul, as ordered toward God.” Beth Felker Jones, Marks of His Wounds: Gender Politics and Bodily Resurrection (New York: Oxford University Press, 2007), pp. 113-14.
48O’Donovan, Resurrection and Moral Order, p. 247.
49Gagnon, “Transsexuality and Ordination,” www.robgagnon.net/articles/TranssexualityOrdination.pdf.
50Ibid., p. 3.
51Ibid., p. 4.
52Looy and Bouma, “The Nature of Gender,” p. 176.
53Heather Looy, “Sex Differences: Evolved, Constructed and Designed,” Journal of Psychology and Theology 29, no. 4 (2001): 311.
54Neil Plantinga Jr., Not the Way It’s Supposed to Be: A Breviary of Sin (Grand Rapids: Eerdmans, 1995).
55There has been some discussion as to whether disorders of sexual development or intersex conditions challenge the idea of ontological significance of male-female differences. Those who argue against ontological significance emphasize the sameness of males and females, pointing to how various intersex conditions remind us that genitalia, for example, comes from the same embryologic tissue. Megan K. DeFranza, Intersex and Imago: Sex, Gender, and Sexuality in Postmodern Theological Anthropology (PhD diss., Marquette University, 2011), http://epublications.marquette.edu/dissertations_mu/117. I think this is an important consideration, but one that does not exhaust the possibilities here, as ontology also refers to the sorting of existing things. One can either highlight the differences between males/females and other aspects of creation, for example, or highlight the differences between males and females. Many would view intersex conditions as actually underscoring those differences at least in terms of how rare intersex conditions are (or, put differently, the frequency by which males and females develop without such complications).
56Looy, “Male and Female God Created Them,” p. 11.
57Ibid.
58Lynn Conway has a helpful summary that includes historical and current global perspectives. See http://ai.eecs.umich.edu/people/conway/TS/TG-TS%20World.html#Hijra.
59Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990), p. 7. This perspective is steeped in queer theory, which is perhaps best understood as a philosophical commitment to epistemology (how we know things and what counts as knowledge) with a focus on deconstruction. See Kelby Harrison, Sexual Deceit: The Ethics of Passing (Lanham, MD: Lexington Books, 2013), pp. 93-111. For a critical evaluation of transgenderism from a feminist perspective, see Sheila Jeffreys, Gender Hurts: A Feminist Critique of the Politics Behind Transgenderism (New York: Routledge, 2014).
60International Gay and Lesbian Human Rights Commission [IGLHRC], Institutional Memoir of the 2005 Institute for Trans and Intersex Activist Training (2005): 7-8, https://iglhrc.org/sites/default/files/367-1.pdf.
61Adapted from Veronica R. F. Johnson and Mark A. Yarhouse, “Shame in Sexual Minorities: Stigma, Internal Cognitions, and Counseling Consideration,” Counseling and Values 58, no. 1 (2013): 85.
62Mark A. Yarhouse and Trista L. Carr, “MtF Transgender Christians’ Experiences: A Qualitative Study,” Journal of LGBT Issues in Counseling 6, no. 1 (2012): 26.
63Jones, “Is Sex or Gender a Choice?”
64Ibid.
65Richard A. Carroll, “Gender Dysphoria,” in Principles and Practice of Sex Therapy, 4th ed., ed. Sandra R. Leiblum (New York: Guilford, 2007).
66Melinda Selmys, personal communication, April 13, 2014.
67Jones, “Is Sex or Gender a Choice?”
Chapter 3: What Causes Gender Dysphoria?
1American Psychiatric Association, The Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Association, 2013), p. 452.
2Anne A. Lawrence, “Proposed Revisions to Gender Identity Disorder Diagnoses in the DSM-5,” Archives of Sexual Behavior 39 (2010): 1253-60.
3Tom Mazur and his colleagues make an interesting observation about conflating intersex conditions with gender dysphoria:
Lumping individuals with intersex with those who are nonintersex but experiencing problems of gender, or who challenge conventional gender boundaries, enlarges the base of minorities, which, hopefully, increases their political influence and the opportunity to gain “rights” previously denied to them. Such blurring of distinctions and inconsistent language use for political (or other) uses can be advantageous; however, merging categories can complicate the work of both scientists and clinicians who are charged with the tasks of elucidating conditions’ etiologies and developing effective treatment strategies.
Tom Mazur, Melissa Colsman and David E. Sandberg, “Intersex: Definition, Examples, Gender Stability and the Case Against Merging with Transsexualism,” in Principles of Transgender Medicine and Surgery, ed. Randi Ettner, Stan Monstrey and A. Evan Eyler (New York: Hayworth, 2007), p. 254.
4Ibid., p. 254.
5This is an interesting development throughout several sections under the influence of the Sexual and Gender Identities Work Group for DSM-5. In the section on the paraphilias, a new distinction is made between the paraphilias and Paraphilic Disorders. A paraphilia reflects a sexual deviation or strong/intense atypical sexual interest. The DSM-5 defines a paraphilia as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners” (p. 685). A Paraphilic Disorder would distinguish those with a mental health issue, which appears to be reflected in whether they are distressed or impaired in some way. According to DSM-5, “A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others” (pp. 685-86). This change reflects the ways in which sexual interests and behaviors are expanding to reflect a range of diverse interests, as well as the reluctance within the mental health field to identify patterns of behavior as reflecting mental health concerns unless the person is already distressed (ibid.). For a discussion of this change, see Mark A. Yarhouse and Erica S. N. Tan, Sexuality and Sex Therapy: A Comprehensive Christian Appraisal (Downers Grove, IL: IVP Academic, 2014).
6Kenneth J. Zucker, “Gender Identity Disorder in Children and Adolescents,” Annual Review of Clinical Psychology 1 (2005): 477.
