Gender dysphoria should be treated with psychotherapy, not surgery. A rare issue of a few men—both homosexual and heterosexual men, including some who sought sex-change surgery because they were erotically aroused by the thought or image of themselves as women—has spread to include women as well as men.
Even young boys and girls have begun to present themselves as of the opposite sex. Over the last ten or fifteen years, this phenomenon has increased in prevalence, seemingly exponentially. Now, almost everyone has heard of or met such a person.
The champions of this meme, encouraged by their alliance with the broader LGBT movement, claim that whether you are a man or a woman, a boy or a girl, is more of a disposition or feeling about yourself than a fact of nature. And, much like any other feeling, it can change at any time, and for all sorts of reasons.
Therefore, no one could predict who would swap this fact of their makeup, nor could one justifiably criticize such a decision. At Johns Hopkins, after pioneering sex-change surgery, we demonstrated that the practice brought no important benefits.
As a result, we stopped offering that form of treatment in the s. Olympic Athlete Turned "Pin-Up" Girl This history may clarify some aspects of the latest high-profile transgender claimant. I have not met or examined Jenner, but his behavior resembles that of some of the transgender males we have studied over the years.
These men wanted to display themselves in sexy ways, wearing provocative female garb. In that tale, the Emperor, believing that he wore an outfit of special beauty imperceptible to the rude or uncultured, paraded naked through his town to the huzzahs of courtiers and citizens anxious about their reputations. Many onlookers to the contemporary transgender parade, knowing that a disfavored opinion is worse than bad taste today, similarly fear to identify it as a misapprehension.
Think, for example, of the parents whom no one—not doctors, schools, nor even churches—will help to rescue their children from these strange notions of being transgendered and the problematic lives these notions herald. These youngsters now far outnumber the Bruce Jenner type of transgender. Although they may be encouraged by his public reception, these children generally come to their ideas about their sex not through erotic interests but through a variety of youthful psychosocial conflicts and concerns.
First, though, let us address the basic assumption of the contemporary parade: It, like the storied Emperor, is starkly, nakedly false. Transgendered men do not become women, nor do transgendered women become men. The most thorough follow-up of sex-reassigned people —extending over thirty years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest.
Ten to fifteen years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to twenty times that of comparable peers. How to Treat Gender Dysphoria So how should we make sense of this matter today? This problematic assumption comes about in several different ways, and these distinctions in its generation determine how to manage and treat it.
Based on the photographic evidence one might guess Bruce Jenner falls into the group of men who come to their disordered assumption through being sexually aroused by the image of themselves as women. He could have been treated for this misaligned arousal with psychotherapy and medication.
Instead, he found his way to surgeons who worked him over as he wished. For his sake, however, I do hope that he receives regular, attentive follow-up care, as his psychological serenity in the future is doubtful. Future men with similar feelings and intentions should be treated for those feelings rather than being encouraged to undergo bodily changes. Group therapies are now available for them. Most young boys and girls who come seeking sex-reassignment are utterly different from Jenner.
They have no erotic interest driving their quest. Rather, they come with psychosocial issues—conflicts over the prospects, expectations, and roles that they sense are attached to their given sex—and presume that sex-reassignment will ease or resolve them.
The grim fact is that most of these youngsters do not find therapists willing to assess and guide them in ways that permit them to work out their conflicts and correct their assumptions. Those with Gender Dysphoria Need Evidence-Based Care There are several reasons for this absence of coherence in our mental health system. Important among them is the fact that both the state and federal governments are actively seeking to block any treatments that can be construed as challenging the assumptions and choices of transgendered youngsters.
In two states , a doctor who would look into the psychological history of a transgendered boy or girl in search of a resolvable conflict could lose his or her license to practice medicine. By contrast, such a physician would not be penalized if he or she started such a patient on hormones that would block puberty and might stunt growth.
Plenty of evidence demonstrates that with him and most others, transgendering is a psychological rather than a biological matter. In fact, gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder.
Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it.
With youngsters, this is best done in family therapy. The larger issue is the meme itself. It has taken on cult-like features: It is doing much damage to families, adolescents, and children and should be confronted as an opinion without biological foundation wherever it emerges.
But gird your loins if you would confront this matter. Hell hath no fury like a vested interest masquerading as a moral principle.
He is the author of The Mind Has Mountains: Reflections on Society and Psychiatry.