from Theological Issues
by Dale O'Leary
How should the Catholic community respond to men and women who think that a sex change operation would solve their problem?
Catholic teaching in this area is clear. It is impossible to "change" a person's sex. Surgery to mutilate the sex organs, hormone treatments, and cosmetic surgery do not change a person's sex.
The 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 University, promoted "sex change" operations for physically normal men who believed they were really women trapped in men's bodies or visa versa--and when the media showcased the "sex changed" individuals--many accepted the idea that it was indeed possible to change a person's sex.
In an article in First Things entitled "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 female looking bodies and found the claim that they were now women unconvincing:
None of these encounters were persuasive, however. 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."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 that they were the other sex, remained unchanged. They still had the same difficulties with relationships, work, and emotions.
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!" He ordered the practice halted at Johns Hopkins and tried to 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. [2]
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.Each cell of a person's body contains chromosomes which identify that individual as either male or female. [4] 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. 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.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." [3]
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. [5] 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 such problems. However, a number of mental health professionals work with and do help such individuals.
Case Studies
For example, a Catholic married man with several children desired 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 males 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 fantasy that he would be safe if he were a female re-emerged.
In his treatment he came to understand the origins of his inability identify with his masculinity. Then he worked on forgiving the males 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 St. Joseph as a role model of male love. A major goal of treatment was to help him see his own masculinity as a positive gift from God.
In another case a tall, athletic, and muscular college student 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 female, 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 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, 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. He is still in therapy but has delayed surgery.
In dealing with clients who have a desire to become the other sex, it is important to not to take the desire at face value, but to uncover the emotional conflicts which has led them to think they would be happier or safer as the other sex. The recognition of emotional pain with peers or a parent leads to the awareness of significant anger which can be resolved through a process of forgiveness. [6] At the same time it is necessary to treat low self-esteem, sadness, and fears.
Many of those who seek surgical sex change suffered from untreated and undiagnosed Gender Identity Disorder as children. 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 Gender Identity Disorder. She had never had female friends, never wore a dress, never used make up, never wore jewelry, or dated a male. She also insisted that her Catholic parents address with a male name, which they agreed to.
Gender Identity Disorder in Children is a treatable condition; however, according to Zucker and Bradley (experts in the treatment of Gender Identity Disorder in Children) "parental ambivalence" is, in most cases "part of the problem." Parents ignore or excuse obvious problems. [7] Zucker and Bradley encourage early intervention, not simply to avoid a later desire for a sex change but to prevent the suffering which the isolation and unhappiness that children with GID experience. In this case, the therapist recommended treatment of GID; the family member never communicated the information to the parents. The young woman recently had her breasts removed.
The other conflicts in those who seek sex change surgery 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 same sex peers; and intense fears with a desire to be protected. A less common conflict is seen in males who have powerful artistic and creative gifts which lead to 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 him as a female, and may even take him to a transgender support group.
Se1f-knowledge, forgiveness, skilled psychotherapy and good spiritual direction can all play a part in the healing process.
References
[1] Paul McHugh, "Surgical Sex," First Things, November, 2004, Vol. 147, pps. 34-38.
[2] Robert Listernick, "A 13-year-old boy who desires gender reassignment," Pediatric Annals, June, 2003, 32/6. pp. 378-382; Yolanda Smith, Stephanie Goozen, Peggy Cohen-ĀKettensis, "Adolescents with gender identity disorder who were accepted or rejected for sex reassignment surgery: A prospective follow-up study," Journal of the American Academy of Child and Adolescent Psychiatry, April, 2001, 40/4: pp. 472-481.
[3] McHugh, op cit.
[4] Gerianne Alexander, "An Evolutionary Perspective of Sex-Typed Toy Preferences: Pink, Blue, and the Brain," Archives of Sexual Behavior, February, 2003, pp. 7-14. The problems of various genetic and congenital abnormalities are not relevant to this discussion. All those seeking "sex change" are physically normal males or females.
[5] John Norton, "Vatican Says Sex Change Operation Does Not Change A Person's Gender," Catholic News Service, Jan. 14, 2003.
[6] Robert Enright and Richard Fitzgibbons, Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope, 2000, American Psychological Association Books.
[7] Richard P. Fitzgibbons and Joseph Nicolosi. "Gender Identity Disorder in Children." Lay Witness, June 2001, www.narth.com.
[8] Kenneth Zucker and Susan Bradley. Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. Guilford Press: NY, 1995, p. 73.