Psychiatrist says sex-change surgery is a
collaboration with a mental disorder, not a treatment.
By Richard P. Fitzgibbons, M.D.
How should the Catholic community
respond to men and women who think that a person's sex change operation would
solve their problem? Catholic teaching in this area is clear. It is impossible
to "change" a person's sex. Hormone treatments, cosmetic surgery and
surgery to mutilate the sex organs do not change a person' sex.
Confusion
in this area has come about because people tend to defer to scientists,
particularly in areas where their personal experience is limited. Therefore,
when doctors, including those from the prestigious Johns Hopkins, have promoted
"sex change" operations for physically normal men who believed they
were really women trapped in men's bodies or women who believed they were men
trapped in women's bodies, many have accepted the idea that it was indeed
possible to change a person's sex.
McHugh concluded that "to provide
a surgical alteration to the body of these unfortunate people was to
collaborate with a mental disorder rather than to treat it."3
He ordered the practice halted at Johns Hopkins and tried to In an article in First
Things titled "Surgical Sex,"
Dr. Paul McHugh, of Johns Hopkins, laid out some of the history of the
"sex change" phenomenon.1 From the beginning, McHugh had
doubts. He interviewed the men for whom the surgeons had created bodies that
appeared female, and found the claim that they were now women unconvincing. He
states:
None of these encounters were persuasive...The post-surgical
subjects struck me as caricatures of women. They wore high heels, copious
makeup, and flamboyant clothing; they spoke about how they found themselves
able to give vent to their natural inclinations for peace, domesticity, and
gentleness--but their large hands, prominent Adam's apples, and thick facial
features were incongruous (and would become more so as they aged). Women
psychiatrists whom I sent to talk with them would intuitively see through the
disguise and the exaggerated postures. "Gals know gals," one said to
me, "and that's a guy."2
When he became psychiatrist-in-chief at Johns Hopkins, McHugh
decided to challenge what he considered to be a misdirection of psychiatry. He
encouraged a study already begun on the outcomes of such surgeries. The study
found that while most of the clients said they were happy with the outcome, the
various psychological problems, which accompanied their feeling they were the
other sex, remained unchanged. They still had the same difficulties with relationships,
work and emotions.
convince others that such interventions were a misuse of
psychiatry and surgery. However, in spite of the evidence, the support for the
idea of "sex change" operations has continued to grow. In fact, there
have been several articles discussing whether it is advisable to begin the
"sex change" process in adolescence or even before.4
McHugh was frustrated to find that
those promoting the practice were not persuaded by empirical evidence:
One might expect that those who
claim that sexual identity has no biological or physical basis would bring
forth more evidence to persuade others. But as I've learned, there is a deep
prejudice in favor of the idea that nature is totally malleable.
Without
any fixed position on what is given in human nature, any manipulation of it can
be defended as legitimate. A practice that appears to give people what they
want--and what some of them are prepared to clamor for--turns out to be
difficult to combat with ordinary professional experience and wisdom. Even
controlled trials or careful follow-up studies to ensure that the practice
itself is not damaging are often resisted and the results rejected.5
Each cell of a person's body
contains chromosomes which identify that individual as either male or female.
It is not simply a question of different genitals. Before birth prenatal
hormones shape the brains of boys to be different than those of girls.6
Mutilating
surgery and hormone treatments can create the appearance of a male or female
body, but it cannot change the underlying reality. It is not possible to change
a person's sex.
In
promoting the truth about the human person, the Church is on the side of
science when it proclaims that it is not possible to change a person's sex.
Therefore, persons who claim to have had their sex changed may not marry or be
ordained.7 A man who is surgically altered
to resemble a woman may not marry a man and a woman with a male appearance may
not be ordained a priest.
Unfortunately,
the promotion of "sex change" operations has decreased investigation
into prevention and therapy for those suffering from gender dysphoria.
However, a number of mental health professionals work with and do help such
individuals.
For example, in one case a Catholic, married man who had several
children wanted to become female. He had completed electrolysis to
remove facial hair and was on hormone treatment. As child he had been unable to
model after his angry father, aggressive older brothers, or hostile boys in the
neighborhood. He viewed men as angry, violent, dark people with whom he could
not identify. Instead, he had escaped from what he perceived as the unsafe
world of men, into a fantasy female world where he felt safe. As he matured,
these fantasies diminished and he married and had children. However, at a
certain point in his career he found himself in an extremely stressful
situation both at work and at home, and his original fantasy about being more safe as a female reemerged.
In
his therapeutic treatment, he came to understand the origins of his inability
identify with his masculinity. Then he worked on forgiving the men and boys who
had hurt him in his childhood and in his adolescence, especially his father and
his brothers. In working with a spiritual director, he slowly came to
experience God as loving father who could protect him, and to develop a
relationship with
In
another case, a thirty-year-old man with excellent athletic abilities was
seeking "sex change" surgery. The therapist he consulted was able to
help him uncover serious emotional conflicts with his mother. She was a
self-centered person and a substance abuser who had essentially abandoned him
as a child. Unconsciously, he thought that if he were a woman, he finally might
receive his mother's love and acceptance. Because he had not experienced a
comforting, loving mother/son relationship, his ability to trust and feel safe
in the world was badly damaged. He thought that if he were a female he might
feel protected in the world. As a result of his regular participation in a
"transgender support group" (which was biased toward encouraging
"sex change" procedures), he came to believe that there was a
biological basis for his belief that he was female. It was extremely difficult
for the young man to admit his problems with his mother, or to acknowledge his
feelings of disappointment, sadness, and resentment. Eventually, through
therapy, he was able to recognize the effects of his mother's dysfunction on
his self-image.
Dealing
with clients who have a desire to become the other sex, it is important not to
take the desire at face value, but to uncover the emotional conflicts which has
led them to think they would be happier, safer and more confident as the other
sex. The recognition of emotional pain with peers or with a parent leads to the
awareness of significant anger which can be resolved through a process of
forgiveness.8 At the same time it is necessary to treat low self-esteem,
poor body image, sadness and fears.
Many
of those who seek surgical "sex change" suffered from untreated and
undiagnosed gender identity disorder (GID) as children. For example, a
therapist was consulted by a member of the family of a young woman who had told
her parents that she wanted "sex change" surgery after graduating
from college. Since childhood, the young woman had shown all the classic
symptoms of GID.9 She had never had female
friends, never wore a dress, never used make up, never wore jewelry or dated a
boy. She also insisted that her Catholic parents address with a boy's name
which they agreed to do.
GID
in children is a treatable condition; however, according to Zucker
and Bradley, who are experts in the treatment of this disorder in children,
parental ambivalence is, in most cases part of the problem with parents
ignoring or excusing obvious problems.10 Zucker
and Bradley encourage early intervention, not simply to avoid a later desire
for a "sex change" but to prevent the suffering, unhappiness, and
isolation that children with GID experience. In the case of this young woman,
the therapist recommended treatment of GID to the family member who asked for
consultation, but this recommendation was never communicated to the parents. The
young woman recently had her breasts removed.
The
other conflicts in those who seek "sex change" surgery experience are
a failure to embrace the goodness and beauty of their masculinity or
femininity, hatred of their bodies, deep resentment with a parent or peer,
childhood loneliness and sadness, rejection by peers of the same gender,
intense fears of being betrayed and hurt, and a deep desire to be protected in
the world. A less common conflict is seen in some boys and men who have
powerful artistic and creative gifts, which lead them to experience a strong
attraction to the beauty in the female world and to an
identification with femininity. This artistic response can begin early
in childhood and can lead to a desire to be female. In rare cases, a parent
wants a child to be of the opposite sex, dresses and treats the child as being
of the opposite sex and may even take the child to a "transgender support
group."
Self-knowledge,
forgiveness, skilled psychotherapy and good spiritual direction can all play a
part in the healing process. Much more work needs to be done
in this field. Parents, pediatricians and educators need to be able to
recognize GID in children. Mental health professionals and priests should
understand the origins of the condition, and know that successful treatment can
occur in persons who come to them with the desire for a "sex change."
Finally, professionals with positive experience in treating this problem need
to share their expertise with others.
Richard P.
Fitzgibbons, M.D.
www.maritalhealing.com
100 Four Falls Center, Suite 312
W. Conshohocken, PA 19428
This
article was first published in Ethics &
Medics, October 2005, Volume 30, 10. It is reprinted by permission
of The National Catholic Bioethics Center, which maintains the copyright. Ethics & Medics is edited by Edward
J. Furton, M.A., Ph.D., Ethicist and Director of
Publications. Web site: www.ncbecenter.org.
1Paul McHugh, "Surgical Sex," First
Things 147 (November, 2004): 34-38.
2Ibid., 34.
3Ibid., 35.
4Robert Listernick, "A
13-Year Old Boy Who Desires Gender Reassignment," Pediatric Annals 32.6 (June 03): 378-382;
Yolanda Smith, Stephanie Van Goozen, Peggy Cohen-Kettenis, "Adolescents with Gender Identity Disorder
Who Were Accepted or Rejected for Sex Reassignment Surgery: A Prospective
Follow-up Study," Journal of the
5Mc Hugh, "Surgical Sex," 37-38.
6Gerianne Alexander, "An Evolutionary Perspective of
Sex-Typed Toy Preferences: Pink, Blue, and the Brain," Archives of Sexual Behavior 32.1
(February 2003): 7-14. The problems of various genetic and congenital
abnormalities are not relevant to this discussion. This essay focuses on the
majority of cases, in which those seeking "sex change" operations are
physically normal.
7John Norton, "
8Robert Enright and Richard
Fitzgibbons, Helping Clients Forgive: An
Empirical Guide for Resolving Anger and Restoring Hope (
9Richard P. Fitzgibbons and Joseph Nicolosi,
"Gender Identity Disorder in Children," Lay Witness (June 2001); also available at
http://www.narth.com/docs/fitz.html.
10Kenneth Zucker and Susan Bradley,
Gender Identity Disorder and Psychosexual
Problems in Children and Adolescents (New York: Guilford
Publications, 1995), 73.