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Caring for people with gender dysphoria

Every once in a while something shows up on Facebook that is worth reading. The other day I ran across a link to the article “Transgenderism: A Pathogenic Meme” by Dr. Paul McHugh. Dr. McHugh is the University Distinguished Service Professor of Psychiatry at Johns Hopkins. Over his long career he has cared for and studied patients with gender dysphoric disorder who present with the concept that they are transgender. He has focused on trying to find what type of treatment best cares for the needs of these patients. He notes that Johns Hopkins was a pioneer in sex-change surgery, but after finding that such surgery brought no important benefits to those who were treated in that way they stopped offering that type of surgery in the 1970s. His conclusion after caring for many patients with gender dysphoria is that this is a mental disorder in which the patients make the problematic assumption that their sexual nature is misaligned with their biological sex. This can occur for several different reasons which are psychological in nature. He would suggest that gender dysphoria “belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder.” The treatment of this type of disorder should “strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it.” He says it does not make sense to treat the person with gender dysphoria with hormones and surgery any more than it would make sense to treat a person with anorexia nervosa with liposuction.

The problem with trying to do what Dr. McHugh has found to be the most beneficial form of treatment for those with this disorder is that it runs counter to a belief that has begun to dominate our culture. Many in our culture have been convinced that a person’s sexuality and gender are based on how that person thinks rather than the characteristics of the person’s physical body. This leads to thinking that there is no possibility that someone’s thinking about things like sexuality and gender could be disordered since how a person thinks determines sexuality and gender. It further leads to thinking that any suggestion that a person’s thoughts about gender are problematic or disordered is offensive and should be prohibited. If that is the case the treatment which Dr. McHugh has found to be the most beneficial way to care for these patients cannot be done.

As Robert George pointed out in his talk at last summer’s CBHD conference, the idea that gender is based on how a person thinks is grounded in the Gnostic idea that human beings consist of a personal mind that lives in a nonpersonal body. It shows why we need to help people understand the longstanding Christian concept that human beings are an integrated unity of nonphysical and physical and that neither the physical nor the nonphysical can be neglected if we are to be whole persons. Our physical bodies are an integral part of who we are as a person and if our thinking denies the truth of our physical reality then our thinking is disordered and that needs to be addressed as Dr. McHugh is suggesting. Then those who have this type of disordered thinking can truly be helped.

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