By Essie Everdeen
No one seems to be discussing the contradictions between what psychology actually teaches about the relationship between our identities and bodies and the popular assertion (supposedly supported by the field of psychology) that some individuals may actually be a male or female trapped in the body of a member of the opposite sex.
In my undergraduate studies, I was taught a theory (widely accepted by cognitive psychologists) called monism – the idea that we are truly and nothing more than our physical bodies. Our thoughts and emotions are different variations of hormones and neurotransmitters being released, patterns of electrical signals going from axon to dendrite, different areas of our brains being activated etc… Others in the field of psychology may disagree with the theory of monism, but they firmly believe in the inextricable link between individuals’ emotions and thoughts and their physical selves. This assertion is based on the growing number of empirical studies which have strongly suggested that our thoughts and emotions are related to our physical selves in ways we have never before imagined. For example, it is now commonly accepted that intelligence, personality, mental health, and even one’s sensitivity to environmental influences (i.e., the biological sensitivity to context theory, the differential susceptibility theory) are largely determined by an individual’s biological makeup.
Whether or not a psychologist believes a person is only his body or a person is his body plus a mind and/or soul, no psychologist will dispute the fact that we are our bodies. This begs the question: if a person is his/her body, how can someone be a “girl in a boy’s body” or a “boy in a girl’s body.” The idea that someone may not truly be his/her biological sex flies in the face of modern psychological teaching that we are inextricably linked to our bodies. Most people intuitively understand that this is the case (whether or not they admit it), but sometimes academics out-smart themselves in the interest of compassion (albeit false compassion) and political correctness.
Many mental health professionals encourage individuals who do not identify with their biological sex to identify themselves as transgender/transsexual and are outspoken about how it is discriminatory to refer to these individuals as an actual members of their biological sex. However, the aim of therapy is to help clients accept their thoughts and desires, but also to accept reality. For example, in cognitive behavioral therapy (CBT) (the most empirically supported psychological therapy) clients are taught to actively challenge their beliefs that conflict with reality. In acceptance-and-commitment therapy (ACT), clients are taught to accept reality, including distressing thoughts and feelings, but also to commit to a course of action to cope with reality. And the list of therapies and therapeutic techniques teaching clients to think and act realistically goes on.
So, why do we encourage individuals to believe that they are actually a member of the opposite sex? This is not a reality; this is unrealistic thinking. And, it is commonly accepted that unrealistic thinking patterns (i.e., unrealistic expectations, irrational beliefs) are linked to psychological dysfunction.
Although effective therapies help a client to accept reality, therapists encourage transgendered individuals to deny their physical reality, by denying that their bodies are true representations of themselves. This is a dangerous precedent to set for therapeutic interventions. Instead of helping clients to accept their thoughts and feelings (“I am sad because I want to be a woman”), but also to accept reality (“However, I have a man’s body, so I am a man”), therapists allow clients to build a pretend world for themselves and play along with them.
Many would argue that gender-reassignment surgery is a valid way to change a person’s reality. But is it? Gender reassignment surgery cannot change the number of X chromosomes an individual has. You may have changed an individual’s hormone levels and reconstructed his or her genitalia, but, if a scientist examined the individual’s DNA, the scientist would identify that DNA as coming from a person of the individual’s biological sex – not the individual’s self-identified gender. Thus, a basic knowledge of biology clearly does not support the idea that gender reassignment surgery truly changes an individual’s sex.
In addition, the famous case of David Reimer’s gender reassignment surgery supports the assertion that gender reassignment surgery cannot change a person’s sex. When David was an infant, a botched circumcision cut off his penis. Psychologists told the child’s parents that the best and easiest way to rectify the problem would be to perform surgery to construct female genitalia for David and raise him as a girl. However, throughout childhood, David preferred rougher games than his female peers, often insisted on urinating standing up, and suffered severe psychological difficulties. Eventually, his parents told him the truth about his biological sex; David immediately requested surgery to reconstruct his male genitalia and began to live as a man. This famous case study has been used to illustrate how important it is to get a client’s informed consent before gender reassignment surgery is conducted, but it also shows that gender reassignment surgery cannot truly change an individual’s biological sex. David was still a man, although his reproductive system was changed as an infant.
Nevertheless, many argue for the use of gender reassignment surgery, citing research that a large majority of individuals are satisfied with and do not regret surgery. However, I think these individuals are a little too sure of themselves. A scan of the available research also shows these things:
– A relative paucity of research on treatment outcomes of gender reassignment surgery (Monstrey, Vercruysse, & De Cuypere, 2009);
– A dependence on short, self-report measures of mental health/life satisfaction in studying treatment outcomes rather than comprehensive, interview measures of psychological functioning (Weyers et al., 2009; Wierckx et al., 2011);
– Contradictory findings in a study utilizing a more comprehensive measure of psychological functioning in individuals before and after gender change surgery (Udeze, Abdelmawla, Khoosal, & Terry (2008);
– A lack of studies with control groups (this is a BIG deal);
– And a low response rate from individuals after surgery (which is surprising – if you were happy about a surgery you received – especially a controversial surgery – wouldn’t you want to speak up?) (Hess, Neto, Panic, Rübben, & Senf, 2014).
Not to mention that there is an alarming trend of giving children and adolescent clients the option of puberty-suppressing hormone therapy, feminizing/masculinizing hormone therapy, and gender reassignment surgery. The use of puberty-suppressing hormones is justified because it allows children to further explore living as a member of their identified gender, while their anatomical structure is still relatively gender-neutral and makes a possible gender reassignment surgery easier to perform later. The latter two interventions are justified because they are seen as treating adolescents’ gender dysphoria and decreasing psychological distress. Medical and mental health professionals are essentially regularly offering children with gender dysphoria – who are not able to fully comprehend all the physical and emotional risks these treatments entail – the option of extreme physical interventions that have yet to undergo rigorous testing (Coleman et al., 2012). For some reason, the fact that these interventions are very new and the fact that the research concerning these interventions is still in the beginning stages does not seem to be regularly mentioned.
And I just have to point this out: whatever happened to all the talk on defying gender stereotypes, how men do not necessarily have to embrace culturally determined masculine characteristics and how women do not have to embrace culturally determined feminine characteristics? Those in the field of psychology have often decried gender stereotyping. Since this is the case, why in the case of transgendered individuals do we forget about the (supposedly) artificial differences between men and women? Why are the struggles facing transgendered individuals not conceptualized as feeling distressed by being expected to conform to culturally determined gender behaviors? I thought that our reproductive systems do not have to affect our sexual choices, our gender identification choices, and our lifestyle choices, so why does a gender reassignment surgery change anything??
Finally, when counselors and psychologists are trained, they are taught that avoiding or overlooking a client’s problems to avoid confrontation or to get the client’s approval actually hurts the client. It is a therapist’s responsibility to help the client accept the realities of his or her life – no matter how tragic or uncomfortable they are. Many times we are like bad therapists – more interested in the approbation of others than speaking the truth. We are afraid of being “the bad guy” so we play along – although it is not in the best interest of others who are confused or have been misled. Similarly, identifying a transsexual (or transgendered) individual as someone other than his biological sex hurts the individual because he is being told that he is someone that he is not; he is being accepted as someone he is not. So, I will leave readers with this question: Whom are we really helping when we identify transsexual individuals as someone other than their biological sex: transsexual individuals – or ourselves?
Further Reading:
http://www.thepublicdiscourse.com/2015/04/14905/
http://themattwalshblog.com/2015/06/02/calling-bruce-jenner-a-woman-is-an-insult-to-women/
References for Psych Nerds (These articles serve as an excellent starting point, but I challenge you to do a search of the research on PsycINFO, paying special attention to the measures used!)
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J.,
& … Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gendernonconforming people, version 7. International Journal Of Transgenderism, 13(4), 165232. doi:10.1080/15532739.2011.700873
Hess, J., Neto, R. R., Panic, L., Rübben, H., & Senf, W. (2014). Satisfaction with male-to-female gender reassignment surgery: Results of a retrospective analysis. Deutsches Ärzteblatt International, 111(47), 795-801.
Monstrey, S., Vercruysse, H., & De Cuypere, G. (2009). Is gender reassignment surgery evidence based? Recommendation for the seventh version of the WPATH Standards of Care. International Journal Of Transgenderism, 11(3), 206214. doi:10.1080/15532730903383799 795801.
Udeze, B., Abdelmawla, N., Khoosal, D., & Terry, T. (2008). Psychological functions in male-to-female transsexual people before and after surgery. Sexual and Relationship Therapy, 23(2), 141-145. doi:10.1080/14681990701882077
Weyers, S., Elaut, E., De Sutter, P., Gerris, J., T’Sjoen, G., Heylens, G., & … Verstraelen, H. (2009). Long-term assessment of the physical, mental, and sexual health among transsexual women.Journal of Sexual Medicine, 6(3), 752760. doi:10.1111/j.17436109.2008.01082.x
Wierckx, K., Van Caenegem, E., Elaut, E., Dedecker, D., Van de Peer, F., Toye, K., & … T’Sjoen, G.(2011). Quality of life and sexual health after sex reassignment surgery in transsexual men. Journal of Sexual Medicine, 8(12), 33793388. doi:10.1111/j.17436109.2011.02348.x
The American Scrivener 