Our Gender Is Not an Accident
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When a man wants to be a woman, or a woman a man, is it because nature gave them the wrong body? Or did something else go wrong?
The idea that a person's sex is a mere biological accident that can be changed to suit one's chosen gender has wide currency today. But, according to psychiatrist Richard Fitzgibbons, this intellectual fad is not at all helpful to people who are genuinely confused about their sexual identity.
Dr Fitzgibbons, who has nearly 30 years' clinical experience behind him, is the director of a private practice outside Philadelphia and leads the team of the Institute for Marital Healing. He has made a specialty of forgiveness therapy in the resolution of excessive anger, and has co-authored a book on the subject with Robert D. Enright, published by the American Psychological Association.
In this interview with MercatorNet he explains why a sex-change operation is not the answer to gender identity problems.
MercatorNet: Are there people who are genuinely confused about their sexual identity—whether they are male or female?
Rick Fitzgibbons: Yes, there are people who are confused due to the seriousness of their emotional pain and conflicts which interfere with cognitive functioning. Many of these individuals have failed to embrace the goodness and beauty of their masculinity or femininity in childhood and in adolescence for numerous reasons.
Unless treated properly, they may go on to hate their masculinity and femininity. Their sadness and lack of acceptance by peers or a parent can lead them to believe that they may be able to escape from their emotional pain and find greater happiness, acceptance and confidence being of the opposite sex.
MercatorNet: It is possible to have a female person "inside" a male body, and vice versa?
Fitzgibbons: No, it is not. A person may feel this way because of emotionally painful experiences primarily with those of the same sex. Initially, they fantasize living as someone of the opposite sex in an attempt to escape from their pain. An excessive fantasy life then can lead to cross-dressing, to a greater identification with the opposite sex and even to a delusional belief that one is of the opposite sex.
MercatorNet: Can a person's sex be changed — surgically or in any way?
Fitzgibbons: No, 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 from those of girls. 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.
MercatorNet: What do follow-up studies show in regard to sex-change surgery?
Fitzgibbons: Dr Paul McHugh reported in an article in First Things that when he was the psychiatrist-in-chief at Johns Hopkins, he studied 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 that they were the other sex remained unchanged. They still had the same difficulties with relationships, work and emotions. Dr 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."
MercatorNet: What are the reasons why people seek to change their sex?
Fitzgibbons: The most common causes are a lack of acceptance and rejection in childhood and adolescence by peers and by the parent of the same sex, deep resentment toward these individuals, hatred of their bodies, intense fears of being betrayed and hurt, and a deep desire to be protected in the world. Less common causes are rejection by the parent of the opposite sex and the belief that if they were of the opposite sex they would receive the warmth and love from that parent which they did not receive as children.
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 and dresses and treats the child as being of the opposite sex.
Finally, many of those who seek surgical “sex change” suffered from undiagnosed and untreated gender identity disorder (GID) as children.
MercatorNet: Can these emotional conflicts be successfully treated? Does the desire for sex-change surgery change after such treatment?
Fitzgibbons: Yes, it is important not to take the desire for sex change surgery at face value, but to uncover the emotional conflict which has led people to think they would be happier or safer 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. At the same time it is necessary to treat poor body image, low self-esteem, sadness and fears.
As with the treatment of substance abuse disorders, spirituality can play an important role in the healing process. We regularly recommend that Catholic patients work with a spiritual director. Also, in those with faith a major goal of treatment is to help individuals to see accept their unique masculinity and femininity as a positive gift from God.
As the emotional conflicts are treated effectively the appreciation for one's unique and special personhood increases. Subsequently, the desire for sex change surgery is resolved.
MercatorNet: How can parents identify gender identity disorder? Can it be successfully treated in childhood?
Fitzgibbons: Gender identity symptoms include strong cross gender identification, exclusive cross-gender play, a lack of same-sex friends and cross-dressing. Children with these symptoms should be treated as though something may be very wrong (link to my GID article at http://www.narth.com). Parents and pediatricians should not minimize or overlook these serious symptoms.
The psychiatric literature clearly demonstrates that children with GID can be successfully treated if both parents cooperate in the solution, especially fathers. According to Dr Kenneth Zucker and Susan Bradley, experts in the treatment of gender identity problems in children, treatment should begin as soon as possible. I have an article on this subject on the website of the National Association for Research & Therapy of Homosexuality.
MercatorNet: Last year the Guardian newspaper in Britain commissioned a review of more than 100 international studies of post-operative transsexuals, after interviewing people who regretted having such surgery, and this research found no robust evidence that the surgery is clinically effective. Why do some scientists insist, even against the evidence, that sex can be changed? What is the bigger issue at stake here?
Fitzgibbons: In spite of the scientific research, 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.
I have personally had the clinical experience recently where a troubled mother found support from two child psychiatrists at different major East Coast university medical centres to begin transitioning her nine-year-old son to a female. Fortunately, the judicial system blocked this medical recommendation, warned the mother and gave primary custody of this boy to his father.
Dr Paul McHugh, whom I referred to earlier, has summed up the philosophy behind this mindset well: "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 clamour 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."
People are coming to believe that they can create, use, change and destroy life as they so choose.
Carolyn Moynihan is deputy editor of MercatorNet.
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