Understanding Gender Dysphoria: Navigating Transgender Issues in a Changing Culture
From the very public transition of Caitlyn Jenner to Emmy Award-winning shows like Transparent and Oscar-nominated films like The Danish Girl, issues related to transgender have taken center stage in public discourse. For many Christians and Christian institutions, transgender issues pose a dilemma. This dilemma can be illustrated by the breadth of denominational responses to transgender issues. A recent Pew Research Center report shows the Episcopal Church and the United Church of Christ allowing for the full inclusion and ordination of people who are transgender, while the Assemblies of God and Southern Baptist Convention officially discredited transgender identity and reject attempts by current or potential adherents to change or disagree with their biological sex.1
It is within this context that Mark Yarhouse, a licensed clinical psychologist and professor of psychology, has written a useful primer for Christians thinking through the nuances of transgender issues, specifically gender dysphoria. Relying on his faith and clinical experience, Yarhouse engages Christians who struggle with understanding the nature and scope of transgender concerns. The book solidly introduces readers to the language, research, prevalence, and treatment of gender dysphoria, with the ultimate aim of demonstrating that those experiencing gender conflict are part of the family of God.
According to Yarhouse, “There is a need for a resource that is written from a Christian perspective and is also informed by the best research we have to date, as well as seasoned with compassion for the person who is navigating gender dysphoria” (10). As a practitioner, Yarhouse has seen the effects of isolation, anxiety, and depression on those experiencing gender dysphoria, some of which he attributes to the church. Many individual Christians and churches see support and pastoral care for those experiencing gender identity conflicts as capitulating to the wrong side of the culture wars. When labeling people experiencing gender conflict as willfully disobedient, Christians are choosing to maintain strong boundaries around the sacredness of a created sex and gender order, rather than engage in the difficult work of reconciliation and redemption. This rigid stereotyping of gender can exacerbate questions about gender identity. Rather than reflecting compassion for those experiencing gender dysphoria, this stereotyping leads to a moral evaluation of the person. Yarhouse asks that we step outside the culture wars in order to provide meaningful ministry for those experiencing gender identity conflict.
Yarhouse helpfully defines the terms necessary to understand the broad experiences of “transgender.” While any and all gender variance can be described as “transgender,” Yarhouse focuses on gender dysphoria, defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) as the experience of having a psychological and emotional gender identity that does not correspond to a person’s sex. Yarhouse situates himself clearly within the evangelical tradition and is sympathetic to those struggling to understand how transgender concerns fit into a sexual/moral ethic. He looks to creation, fall, redemption, and glorification to explain how the sacred creation of male and female became corrupted by the fall, concluding that the lack of congruence between birth sex and gender identity—a result of the fall—does not separate us from God’s care and love.
Yarhouse describes three frameworks that tease out the ways we have consciously and unconsciously evaluated gender identity concerns and identifies problems with each. The integrity framework is based in the complementarity of maleness and femaleness, placing sex as the primal part of humanity. Deviation from stereotypical femininity and masculinity then becomes a moral issue. The disability framework avoids moral evaluations by casting gender dysphoria as a medical condition that people do not choose. This evaluation, however, may lead caregivers to appeal to God’s created intentions and to the maintaining of biological sex at the expense of a person’s experienced gender identity. The diversity framework celebrates and honors gender identity in whatever form it takes, allowing people experiencing gender incongruence a way to make meaning out of who they are. Wary of the latter framework’s rejection of traditional sex and gender norms, many Christians reject the diversity of a sex or gender continuum, leading in turn to rejecting those experiencing gender conflict.
To bridge these frameworks, Yarhouse suggests an integrated framework that upholds the integrity of two distinctive sex categories as important and sacred elements of creation. The disability framework supplements the integrity framework with empathy, seeing gender dysphoria as a reflection of the fallen world. Adding elements from the diversity framework provides ways to validate a person’s felt gender experience meaningfully. Rather than seeing deviation from traditional categories as willful disobedience, Yarhouse believes that Christians can maintain the integrity of traditional gender ideals, recognizing that in a fallen world, people do not choose gender dysphoria.
Yarhouse draws on these frameworks throughout the remainder of the book as he discusses the causes, prevalence, and treatment of gender dysphoria. Gender dysphoria is rare and the causes are unknown. Yarhouse reviews three current theories that attempt to explain pathways to gender dysphoria: the brain-sex theory, Blanchard’s typology, and multifactorial models of causation that emphasize psychosocial factors. Each of these areas of research is limited, leading Yarhouse to caution readers to reflect thoughtfully on any causal model. He then discusses the phenomenology, prevalence, and treatment options for gender dysphoria, stressing that his preference as a practitioner is for patients to resolve their gender conflict through the least invasive means possible.
Yarhouse closes his book addressing how individual Christians can develop a more reasoned response to gender dysphoria. He believes the key is to listen carefully to understand how an individual is experiencing gender conflict. Yarhouse critiques a traditional evangelical approach predicated on the belief that to belong to a church, you first must behave in ways that illustrate you believe “rightly”: that right behavior, as a sign of proper belief, then allows you to belong to the church. Opposed to this conditional approach, Yarhouse offers a “missional” approach that focuses on belonging to a church body first. Belonging is about relationship that can move a person toward belief to become more Christ-like. This missional approach gives individual Christians and churches a way to show compassion, learn from, and faithfully care for people experiencing gender dysphoria.
Creating communities focused on relationship means, first, that Christians must resist upholding the distinctions of biological sex and social gender norms to the point of accepting only rigid stereotypes as a bulwark against the larger cultural values of inclusivity and diversity. Second, Christians must resist embracing inclusivity and diversity at the expense of denying the sacredness of sex differences, which could lead to a devaluing of the authority of Scripture. This seems an unresolvable tension; theological commitments can be confounded by ideological commitments to traditional sex and gender norms at the expense of community (as can commitments to sex and gender diversity at the expense of Scripture). As sociologists have noted, American evangelicalism thrives when it is perceived as embattled. This sense of being persecuted for maintaining strong and distinctive subcultural boundaries leads individuals and churches to cleave more tightly to traditions that are at odds with the prevailing culture. Yarhouse walks a fine line evaluating gender dysphoria and other sexual ethic concerns, hoping to sway Christians with data and logic. Ideological commitments, however, seem immune to those tactics. While critically engaging the scholarship on sex and gender may successfully engage people who want a better understanding of gender dysphoria, it may not be compelling to those who wish to maintain a strict division between being in the world but not of it.
Yarhouse lays the groundwork for a thoughtful Christian response to gender dysphoria. One of his concerns is that Christians tend to equate gender dysphoria with homosexuality. Yarhouse strives to separate a clinical diagnosis of gender dysphoria from homosexuality in order to shift the conversation from a moral to an empathetic evaluation. Yet stressing that people do not choose gender dysphoria implies that people choose homosexuality. In order to sensitize his audience to this one LGBT concern, he may unwittingly be allowing the other categories—lesbian, gay, and bisexual—to be considered groups whose moral evaluation sets them outside of the church.
Grounded in his faith, clinical experience, and the current research, Mark Yarhouse’s Understanding Gender Dysphoria allows Christians who hold sex and gender as sacred and essential a way to think about transgender concerns more thoughtfully. Yarhouse is sympathetic to two audiences: evangelical Christians and people experiencing gender dysphoria. For Christians who are unfamiliar with the complexity and variation of transgender concerns and seek a more thorough understanding, this is a useful book. For people who are unwilling to complicate their understanding of transgender concerns, as well as for those committed to inclusivity at the expense of scriptural authority, the book may prove unsatisfying.