Gender Dysphoria Christian pastoral care and transgenderism
What is it?
We do not live in Paradise and that manifests itself in many forms of brokenness and paired with that is suffering. A very unique and bitter form of this brokenness presents itself in the appearance of gender dysphoria, also referred to with the term transsexuality, or more recently, transgenderism. Gender dysphoria is “the subjective experience that there is an antithesis between the development of the body according to gender and, on the other hand, the feeling of identifying oneself as either man or woman”. A different description (of far-reaching forms of gender dysphoria) is: “Transsexuals have, in spite of the inner and outer organs pertaining to one gender, the irrefutable belief that they belong to the other gender. For them, this belief leads to an aversion of their own sexual characteristics and they cherish the wish and express it emphatically, to be physically adapted in as far as possible to the gender to which they feel they belong”.
How is that experienced?
People with dysphoria often put their own problem into words in terms of “being in the wrong body”, or “having a wrong packaging”. Foremost, they experience a deep aversion to their own body with regard to the sexual parts, sometimes so much that they turn to self mutilation. They want to dress themselves as someone from the sex they feel they belong to, a MF transexual (man who feels himself to be a woman) wants to use makeup like a woman, a FM transexual wants to urinate standing etc.
This all sounds strange and when we first hear of it, then our reaction can be: What kind of queerness is this? However, experience teaches that it is about a very deep experience and a bitter problem that merits being taken seriously.
What does it involve?
Gender dysphoria is a problem of gender identity, that is to say, the consistent and enduring belief of being a man or a woman, not only according to the outward characteristics of the sex, but also psychologically, in the self-image and in the social relationships. In by far the most cases, a person is satisfied with the role that accompanies this being man or woman. In this connection, we use the term ‘gender role”. Gender identity and gender role are normally closely connected. In practice, however, it appears that an antithesis is sometimes experienced. For example, a man fulfills the male gender role, but experiences himself as a woman and desires to have the gender characteristics of a woman and to fulfill the role that goes with it. Gender dysphoria occurs in men as well as in women. Research reports that it is about 1 in 30 000 women and 1 in 10 000 men. Still, all together it is about a large group of people with a gripping problem.
Along side this, it is appropriate to remark that with gender dysphoria it is not about an all or nothing situation. With serious forms of gender dysphoria, a complete transsexual development takes place, which, among other things, means that one, already before the age of six, shows the behaviors of the other sex. These people, as young children, played, preferably, with toys that were typically associated with the opposite sex. Others only come to experience gender dysphoria at a later age, from the time of or after puberty, and not permanently.
People who experience gender dysphoria also see themselves as someone from the opposite sex to what they are physically, in the man-woman relationship. In this way a man with gender dysphoria, who experiences himself as a woman, is attracted to (heterosexual) men.
The Cause and the image of man
The cause of this phenomenon is not known; most likely it does not have a specific cause. It may have to do with interference during the prenatal development in the hormone balance, this together with deviations in the normal development of the brain. These deviations from the normal sex determining development could possibly (along with other factors) be caused by external factors such as the situation in the family and the possibility of identifying with the parent of the same gender. It is probably about a complex coming together of many factors.
An important question is what gender dysphoria means for the image of man. To me, it seems important here, to differentiate between the plateau of being and the plateau of experiencing. The plateau of being refers to how a person is “put together”; the plateau of experiencing refers to self-image and self-experience. Sometimes gender dysphoria is described as: there is a male spirit (or soul) in a female body, or vice versa. But is that really so? According to the Bible, man is a spiritual-physical unity created after God’s image, in two forms or genders, male and female (Gen. 2:7). The relationship between spirit (or soul) and body is a mystery. But we also believe that God, in every sense, is the Creator of man and with that, also of that spiritual/physical unity. The thought that a woman’s spirit can be paired with a man’s body presupposes in the first place that spirit and body exist separate from each other and in the second place, that, with the coming into existence of a new person (with the fertilization of the egg), “by accident” a “wrong” spirit can come into the developing body. This does not fit with the way in which I understand the Bible on this point. It appears more acceptable to me that, from the beginning, the fertilization of the egg, which determines the gender, we speak about a person, developing in the spiritual and in the physical manner. Further, it appears that in this development all kinds of things can go wrong, in every dimension of existence: physically, intellectually, psychologically, and spiritually. One of the things which can go wrong is a disturbance in gender identity. That gives the experience already described.
Forms of giving help
I want to point to three ways in which help is given: the medical/technical (changing the structure), the psychiatric, and the pastoral way. These can to a certain extent exist beside each other.
a. Sex reassignment procedures
In our society, where we mostly seek technical solutions for our problems, also for gender dysphoria, a medical/technical procedure has been developed. It is about sex reassignment procedures, a series of hormonal and surgical treatments whereby one gives to the transsexual person, in as far as is possible, the outward gender characteristics of the desired gender (the transsexualization or conversion). It is clear that this is about very invasive, for the most part irreversible interventions, which are only carried out after a psychological consultation. At that time, among other things, it is made clear that the interventions do not lead to a normal physical functioning as member of the other gender, and in every case lead to permanent sterility. The treatment is carried out in phases, and the patient can stop any time he or she desires to do so. A portion of the people, after such an intervention, feel happier (less unhappy). Still, many remain unhappy, partly also because the person sometimes becomes socially isolated.
For the people in the immediate social structures around the person who lets himself be “reassigned”, it is also a traumatic experience, especially when it is about someone who is married and already has children. Try to imagine the consequences.
b. Psychiatric treatment
These have not received as much attention in the Netherlands as the “restructuring”. The results are also not overwhelming. Still, especially with young people, there appear to be possibilities and positive results have been reported. In every case, the treatment is on the plateau where the problem lies, namely, at the disturbance in identity.
c. Pastoral care
Also in the Christian congregation, there are people with gender dysphoria. Often people do not dare to let it be known, out of fear at a lack of understanding and of rejection. When an office-bearer hears of someone in the congregation who has such a problem, then, I think, the following issues are of interest (without delving into thorough description)
- Considering the nature and seriousness of the problem, the minister needs to be involved.
- In the first place, show understanding of the difficulty and of the struggle, listen much and do not judge quickly, even more than usual in pastoral work. In his difficulties and in his being torn apart, he or she must be made to feel accepted as brother or sister within the congregation. Velema uses the words: empathetic, feeling, sympathetic, but following this, also cautious, and finally penetrating, but not forcing. This last one is important, in particular, when transsexualization is brought up.
- As far as the ethical approach to the problem goes, I concur with W.H. Velema who speaks about a gentle “no”. The “no” is about not being able to support the person in a decision for genital adaptive procedures. “Gentle” is important because, considering the complexity of the problem and of the seriousness of the suffering, someone who does decide for such procedures, must be held on to pastorally, as much as possible, and should not be put under church discipline.
- The pastorate must thus be focussed, possibly in combination with psychiatric treatment, on helping the other with his or her problem, still to be able to live without going over to sex reassignment procedures. But, should that still happen, then it is important to try to hold fast to that member of the congregation.
- In your pastoral work, do not forget the family!
- In the role of the congregation surrounding this issue, prayer will play a huge role. In that prayer, one may also ask for mitigation of the experienced suffering and for healing of the disturbed identity. According to my insight, the office-bearers should seriously consider whether perhaps a special prayer activity is desirable; very difficult cases sometimes ask for special procedures (Mark 9:29).