Wednesday, 29 April 2015

Understanding Gender Dysphoria

“Gender dysphoria is a condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity.” (NHS website) It is not about sexual attraction or orientation and is to be distinguished from disorders of sexual development.

Mark A. Yarhouse has  a book that is scheduled to be published in July 2015 under the title Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture. The first chapter can be read here. The video of a talk based on the book given at Calvin College is accessible here.

What causes someone to experience gender dysphoria? We don’t know. Yarhouse does not believe that the condition can be explained by environmental factors.
The most popular theory of causation today is called the brain-sex theory...The theory is based on the understanding that sex differentiation of the genitalia and sex differentiation of the brain occurs at different stages of fetal development. The idea is that perhaps in rare instances the genitals develop in one direction while the brain develops in the other direction.
Other theories of causation … tend to be multifactorial models with more consideration given to psychosocial factors. Proponents of these models suggest there are–in addition to prenatal/biological considerations–differences in areas such as temperament, level of anxiety, sensory reactivity, same-gender parental identification and modeling, and early childhood trauma that may also be part of the picture.
(The citation here is from a blog post of his.) Yarhouse does not think that we have sufficient data at present to settle the matter.

Can and should gender dysphoria be treated? Most cases actually resolve before a child reaches late adolescence or adulthood. The options for intervening around gender dysphoria in childhood are essentially the following
  • facilitating congruence between one’s gender identity and one's biological sex,
  • facilitating a cross-gender identification,
  • waiting to see what will occur over time,
  • artificially delaying puberty to allow a child to decide about gender identity in later adolescence.

From 39:28 in the video Yarhouse outlines how he seeks to help people to navigate the territory of gender dysphoria and from 53:11 he presents the three most prominent orienting frameworks within which people approach gender dysphoria, before suggesting an integrated framework that allows for insights from all three. The three lenses are
  • integrity: “identifies gender dysphoria as confusing the sacredness of maleness and femaleness and specific resolutions of gender dysphoria as violations of that integrity.”
  • disability: “identifies sexual identity issues and gender dysphoria as reflections of a fallen world in which the concerns are more likened to a disability, a nonmoral reality to be addressed with compassion.”
  • diversity: strong form – deconstruction of gender/sex as oppressive; weak form – highlights sexual identity and gender identity issues as reflecting an identity and culture to be celebrated as an expression of diversity.[*] 

Yarhouse argues that knowing about these different lenses with which people look at the issue helps us to avoid talking past each other, facilitates cognitive complexity and perspective-taking, and allows us to draw on the best each framework has to offer which he seeks to do from about 1:03:47 onwards. Implications for pastoral ministry are drawn from 1:05:21. 

[*] An advocate of the first framewok would be Robert Gagnon who writes of transsexuality as “an explicit denial of the integrity of one’s own sex and an overt attempt at marring the sacred image of maleness or femaleness formed by God” (“Transsexuality and Ordination,” 2007).
For the second lens compare Karen Keen’s use of the distinction within the world of hearing loss between people who identify as “Deaf” (capital-D, people with hearing loss are seen to form a distinct culture) and those who identify as “deaf” (small-d, keen to overcome the distinction between them and others and hence, e.g., happy with cochlear implants) within the context of sexual identity.
Yarhouse gives a citation from Joshua Butler to illustrate the strong form of the third framework but notes that in his experience the weak form is far more commonly held among people with gender dysphoria.