Transsexuality and Christian Ethics:
Introduction: Questions and fears
It is not surprising that little has been written about transsexuality from a Christian perspective. It is a relatively rare condition, which was not properly described until medical and surgical procedures became available in the second half of the twentieth century, and its cause is still a matter of research. This very lack of clarity also helped give rise to those questions which dominate the current ethical debate about the condition. Is it, as transsexuals themselves claim, triggered most probably by a neurological or genetic abnormality, to which psychotherapy will always be a misguided and fruitless response - or is it a psychological condition - in essence a fantasy which denies bodily reality? Is it a medical problem, treatable effectively only by medical means (including surgery) - or not? These questions, in turn, raise others about the nature of the body, of the nature of gender and of the nature of the boundaries that society erects. It touches a raw nerve in our understanding of the relationship between nature and nurture (essence and construction) in the formation of the human self.
Perhaps the two oldest objections to male cross-dressing have been that it was feared to be either as an act of breaking and entry into the harem, or else as cover for homosexual relations. Any crossing of boundaries may, of course, be unsettling and those of sex and gender especially so. In particular, the fear of deception is real, as illustrated by the recent sensationalist reporting of a television programme in which a group of young males were to be 'deceived ' into having oral sex with a pre-operative transsexual who was 'still a man.' Those suspicions still characterise the argument of those who today doubt, deny, or make light of even the possibility of a physiological basis for gender dysphoria.
In Britain, Oliver O'Donovan's 1982 study, 'Transsexualism and Christian Marriage' and the 2000 report 'Transsexuality' by the Evangelical Alliance, though both openly dismissive of transsexuality, have set the agenda for future debate, which has been taken up most recently by the Church of England's 2003 report 'Some Issues in Human Sexuality'.
All three documents set out to describe transsexuality and its causes, they look to scripture for guidance, and then comment on the significance of the body and of the self in relation to that. The two earlier studies are largely dismissive of any physiological cause for transsexualism. In O'Donovan's case, this is more readily understandable. In 1982 far less was known about the causes of transsexuality than it is now, and in particular, research on the significance of brain form and function in determining gender identity had not begun. The Evangelical Alliance do refer to this research, but dismiss it out of hand as 'very limited' and 'notoriously difficult to perform and unreliable.' They wish to believe, in essence, that transsexuality is a psychological disorder and that every attempt should be made to help transsexuals to 'accept' or 'come to terms with' their apparent 'God-given' biological gender. They also believe that attempts to alter the body are a Gnostic denial of its givenness.
'Some Issues' attempts to offer a more considered and balanced discussion of the issue, but it only succeeds in part. The concerns raised by O'Donovan and the Evangelical Alliance and, in particular, their dismissal of the physiological basis of transsexuality, are not challenged with sufficient rigour. It begins, for example, from the premise (7.2.4) taken directly from the Evangelical Alliance's report, that 'in the case of transsexuals, there is no doubt about their biological sex. In terms of their genetic, physical and hormonal characteristics [transsexuals] unambiguously belong to the sex to which they believe they do not belong.' In what appears to be an attempt to be even-handed and to give due defence to the views of the Evangelical Alliance, 'Some Issues' suggests (7.4.15) that psychotherapy is a valid alternative to medical and surgical treatment of those with gender dysphoria, and cites (but at second hand) research which appears to confirm that pyschotherapy can be a successful therapeutic option (7.2.5).
Much, however, has been learned since that research was published in 1981. The Cleveland clinic in which it was carried out still employs counselling to address problems of depression and anxiety and to improve self-esteem, and particularly amongst children reports some success in enabling some individuals to function better within their biological gender, but it no longer regards pyschotherapy as an alternative to surgery. In common with all other such clinics which follow internationally recognised Standard of Care for gender dysphoric persons, after proper psychiatric or psychological diagnosis, it carries out full gender reassignment through medical and surgical means. Counselling and psychotherapy may be a valuable part of the treatment of transsexuals, but is not now regarded as a valid alternative to hormonal medicine and surgery. Instead, it has more typically become a means of helping transsexual people cope with the guilt and anxiety they have too often suffered. The damage caused by misguided attempts to find a 'cure' for transsexuality are now widely recognised as serving only to deepen the traumas associated with gender dysphoria and as, such, it is a matter of no little regret that the Church of England should be appear to endorse the validity of such unhelpful and damaging practices. More generally, this naïve and uncritical attempt at balance, shown in its ignorance of current medical and pyschological research, sadly and seriously undermines the whole discussion of transsexuality in 'Some Issues'.
Transsexuality and the Bible
First of all, it is clear that although the Bible richly illustrates the significance of gender in human relationships, its main concern is not with the nature of gender per se, but with the nature of those relationships within the faith community and with God. The givenness of gender and the possibility of procreation is secondary to wider issues of grace, faith and hope.
Secondly, the givenness of sex and of gender is part of the economy of creation. But as Rowan Williams points out, sex is both comic and tragic. It is the place where "the awful incongruity of our situation can break through as comedy, even farce" - but "on the edge of pain." A reading of the Song of Songs or of John 19:34 as coloured by Janet Martin Soskice's tracing of an extraordinary medieval tradition in which Jesus is seen as a mother, extended in the most vivid imagery to the "physical side of what mothers do - bleed and feed", certainly brings the tragi-comedy and the pain associated with it into focus. Sex and gender do indeed seem to be an aspect of God's play, a play which invites, even demands our active response if its fullest meaning is to become clear. It is an aspect of ourselves to be discovered in relationship and not a rigidly pre-determined and restrictive given. Our part in the play of sex and gender in Christ is primarily an aspect of grace, not of law. Those who insist that the witness of Genesis is to a strictly differentiated dimorphic understanding of sex and gender run the risk of ignoring the dimension of grace and instead impose what often appears to be a narrow, falsely-founded legalistic and culturally conditioned view.
Simply repeating the mantra of 'non-negotiable datum' fails to recognise the breadth of human experience and stretches the biblical texts well beyond their proper intention. Paul's reminder that the body is a temple of the Spirit is a timely corrective, for the Spirit leads us into all truth through a living, faith-imbued relationship with God and with other people. It is a process of becoming.
Thirdly, the Bible's strong emphasis on the significance of relationship and of community is also a corrective to the excessive liberalism which suggests that individual will and freedom of choice takes precedence over the common good. Societies need boundaries, and in as far as we live by law as well as by grace, sex and gender are properly accorded different boundaries in different cultures and contexts. But, as can be very clearly seen, these boundaries are not fixed for all time. It is an indictment upon society's and the church's inability and failure to live out the biblical call to community that individuals are placed in the sometimes suicidal void between humanly constructed and artificially exaggerated sex and gender stereotypes. We must be careful not to give uncritical and unthinking blessing to societies' norms. As Deborah Sawyer has shown, the Bible is sometimes surprisingly subversive about gender roles. God, it seems, has a strong sense of humour. We need to laugh at ourselves too.
Transsexuality and the Body
'Some Issues' concludes its discussion of transsexuality with this question:
'At the heart of the matter is the question of the Christian understanding of what constitutes our God-given identity as human beings. It has traditionally been held that one of the implications of the Christian belief in the resurrection of the body is that it shows that our bodies are integral to who we are before God. We are not simply people who inhabit bodies, rather our bodies are part of who we are. If this is the case, what are the theological grounds for saying that, in the case of the people with gender dysphoria, their 'true' identity is different from that of the body with which they were born? Can we go down this road without moving to a new form of gnostic dualism in which the body is seen as separate from the self?'
This is a serious question to which the immediate response, of course, is examine whether or not people with gender dysphoria (and those who treat them) really do believe that their bodies are separate from their selves, and, if they reject that, whether or not such an assertion is justified.
My interviews with transgendered people show very vividly that they do not deny the createdness of the body, they do not seek to justify a false, dualistic, mind-body split, but take their bodily experience very seriously indeed. There is little or no attempt to deny the givenness of gendered identity. It is simply not the case that transsexuals claim to have a 'real' sex that is different from the sex of their bodies, but their sense of dysphoria is located in embodied experience. It is not so much a case of being 'in the wrong body', but of trying to cope with a conflict within the body and of seeking to find some resolution of that conflict in bodily terms. A female-to-male transsexual thus describes his experience of an encounter with a (Christian) gestalt therapist, a realisation that was eventually to lead to gender reassignment:
"Basically, he almost gave me permission to explore myself and to become my own person, to come out of my head and live in my body, and that was just an incredible experience."
Especially if biological factors are a major component of gender dysphoria, as convincing evidence now seems to suggest, and that our gender identity is both more complex and also dependant upon many more factors than those readily observable when a child is born, hormonal and surgical procedures are best understood as a appropriate medical response to a medical problem. The resistance of gender dysphoria to other therapies, including psychotherapy stands in stark contrast to the correspondingly outstanding success of medical and surgical procedures in releasing people to live fulfilling and productive lives. Of course, there are always exceptions and failures, but these are rare (in one recent study less than 1% of female to male transsexuals and less than 1.5% of male to females). Is gender reassignment in the words of Robert Song (and quoted at length in 'Some Issues') "a therapeutic intervention against disease and bodily disorder, as a sign of the Kingdom which is the restoration and fulfilment of creation" or not? The evidence from those who suffer from gender dysphoria, and emphatically so from those who treat them, bears vivid witness that it is indeed just so, or at least that in the light of our present knowledge of the condition, at the very least, it represents the only real solution.
Sex(uality) and Marriage
The Evangelical Alliance believes that to accept gender re-assignment is to condone same sex relationships. Underlying this concern, it is possible to detect the sense of unease about the crossing of boundaries illustrated by the story of the young men deceived in the making of the television show. Whilst it is important to recognise the gut strength of feelings aroused by such a story, and to recognise the deeper issues to which those feelings bear witness, it is perhaps, not wholly helpful to reduce a consideration of transsexuality to one of whether or not the existence of transsexual people undermines the very foundation of Christian marriage as being between one man and one woman. It is possible to smell here the same kind of fear as satirised described by David Lodge in his sharply perceptive 1980 novel about attitudes amongst Roman Catholic young people in the early 'fifties to contraception :'How Far Can You Go?' Could the practice of 'artificial' birth control be the first falling domino from which the complete collapse of Catholic doctrine would follow?
Transsexuality is far less common than the media attention given to it suggests. One widely accepted estimates suggests that there may be as few as 5,000 post-operative transsexuals in the UK. Some studies show that sexuality may change as a result of hormone therapy and surgery, but in the majority of cases it does not. Also, as the instance of homosexuality amongst pre-operative transsexuals is not significantly greater than in the general population, the number of people seeking to marry after surgery is (relatively) very small indeed. Is the Kingdom more clearly to been seen in not recognising the healing offered through gender reassignment or in accepting it? Would such an acceptance really undermine traditional understandings of Christian marriage? To fail to recognise such gender reassignment as healing is surely tantamount to an acceptance of the stance articulated (by a few) that 'God does not make mistakes'.
It is important to see transsexuality neither as a cover for homosexual practices, nor as a flight into fantasy. It is clear both from transsexual people themselves and from those who treat them that, whatever the cause of the condition, if untreated, it turns from a life-sentence into a death sentence. An attempt to expand or to blur gender boundaries may liberate some people, but it does not address the real nature of the conflict experienced by those who suffer from gender dysphoria. Psychotherapy alone is an ineffective and misguided response to the condition.
The only real test of the efficacy of medical and surgical treatment is whether or not individuals are healed. There is, of course, much room for debate about what healing might mean, but in this case, it must surely be seen to result in individuals freed from anxiety, depression and stress and in the setting free of those individuals to live, not in denial of givenness of the body, but to find fulfilment through the use their bodies to contribute more fully to the life of the community - the biblical foundation of gender in the economy of creation. Gender is God's gift, but it is intricate, delicate and formed through an exquisite interplay of biology, psychology and culture. The transsexual person may seem to represent a threat to the fragility of gender, but if we can put aside our fear surrounding the crossing of boundaries so deep that they can be mistaken for being sacred, she may also help us to a new and more profound understanding of the true nature of that gift.
(Revd.) Helen Savage, herself a pre-operative male to female transsexual, is carrying out doctoral research at the Department of Theology, Durham University, into transsexuality and Christian ethics.
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