What Body Dysmorphic Disorder and Gender Identity Disorder Have in Common

Toby SheldonEarlier this week while on an elliptical trainer at the gym, I watched a portion of The Doctors airing on the TV monitor above me, all about a 33-year-old man, Toby Sheldon, who has spent more than $100K for plastic surgery to make him more closely resemble Justin Bieber. A desire to look like Justin Bieber seems to me like prima facie evidence of mental illness; sarcasm aside, I find his behavior deeply disturbing. People who voluntarily and repeatedly go under the knife to change their appearance have always struck me as painfully confused, trying to fix something wrong within them by changing their exterior. Toby admits to being “obsessed” with having a youthful appearance (and many people want plastic surgery for the same reason), but given his relative youth when he underwent his first surgeries, it seems likely that age is a stand-in for something else. My guess is that he felt badly about himself, “ugly” on some profound level, and he “explained” that feeling with reference to hair loss and the age-related droop of his flesh.

In numerous other interviews, Toby has insisted that it’s not so much about looking like Justin Bieber as having the same youthful features. This seems like a distinction without a difference: if you want only to appear more youthful, why not strive to reclaim a younger version of your own features? Toby has also said that when Justin Bieber first burst on the scene to enormous acclaim, he, Toby, felt extremely envious of Bieber’s success. This statement seems closer to the mark. Toby seems delighted to tell reporters that he is occasionally mistaken for the star. If only he could become Bieber’s identical twin, then maybe he wouldn’t feel so ugly inside. In the other interviews I’ve watched, Toby is always talking about how happy with his appearance he now feels. The TV segment regularly cuts to shots of Toby consulting his own image in the mirror, endlessly examining his features and arranging his hair. This preoccupation with his looks doesn’t convey a sense of well-being, at least not to me. It seems obsessive: Am I really okay? Do I still look young? Maybe I was wrong — I’d better check again.

It will come as no surprise that I view this as a shame-related issue. As I’ve often said, core shame is an extremely painful experience of internal defect or damage, often consciously felt as “ugliness.” For people like Toby Sheldon who suffer from Body Dysmorphic Disorder, the shame is displaced from the inside onto their appearance. The search for a “solution” to shame then focuses on altering one’s features — losing weight, getting fit, or in extreme cases, finding a plastic surgeon to “fix” you. In one interview, Toby spoke in ecstatic terms of seeing his own reflection after one of his latest surgeries: “That’s who I’m supposed to be!” Like all narcissists who escape from shame into an idealized false self, Toby has shed his damage by taking refuge in a new-and-improved Justin Bieber self, one that “disproves” all that unconscious shame. Now he has become the perfect undamaged person he was always meant to be.

At the risk of offending the politically correct LGBT crowd, I will state my personal view that Gender Identity Disorder involves the same process. The experience of profound shame (resulting from an emotionally catastrophic infancy and early childhood) is equated in the person’s unconscious mind with her anatomical gender. This usually occurs at a very early age, often before language develops; it is for this reason that the transgender person will argue that she has “always felt that way.” For all intents and purposes, she has. On an unconscioius level, she early on came to believe that she was actually a boy trapped in a girl’s body; in later life, she convinces herself that surgically altering her body is the solution to her psychological pain, her depressive feelings, her sense of being an outsider. Gender transition is the solution to shame, just as plastic surgery is the solution to shame for people like Toby.

My views on this subject aren’t purely theoretical, though I confess I am no expert in transgender psychotherapy. One of my long-term female clients was very male-identified and in her early 20s had a long-term sexual relationship with another woman. My client often felt as if she were an angry little man trapped inside a woman’s body; she tended to idealize men to an extreme degree, believing that the possession of a penis meant they had no problems of any significance. She often wished she were a man and at least in the beginning of our work, often came across as a caricature of one: gruff, swaggering, aggressive. Over time, we came to understand that she had identified her shame with her more physically vulnerable gender, especially her vagina — that smelly black festering wound in her body. Helping her to address the real source of her shame and rehabilitate her femininity was the work of many years.

Also, on a factual basis, there is no scientific evidence to substantiate the theory that people are “born into” bodies with genders that don’t match their emotional, psychological genders. I accept that many transgendered people have “always felt that way,” at least for as long as they can remember. These defensive identifications occur at a very early age, much earlier than what we see in someone like Toby. You know I don’t put much stock in diagnosis, but using the DSM labels currently in vogue, I would say that Gender Identity Disorder is a specific, severe form of Body Dysmorphic Disorder. Core shame drives them both, with gender re-identification functioning as a powerful defense against it.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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92 Responses to What Body Dysmorphic Disorder and Gender Identity Disorder Have in Common

  1. YOHAMI says:

    Joseph Burgo for the win.

    • RM says:

      I’m still laughing at your post Yohami, forewarning a highly fascinating post and debate! You were spot on!

      Joe, thank you for being so brave, knowing you would cop some flack – but going ahead anyway. It has certainly expanded my understanding of the issue. I never thought of it that way before, it makes sense. I personally prefer to live in a world where the status quo is continually challenged. We need more people like you Joe putting forward their considered views, despite the inevitable fall back from the PC thought police!

  2. Lauren says:

    Okay, Joe…I’ve been reading your stuff for over a year, now. I respect you tremendously, read one of your books repeatedly, and these concepts have had a profoundly positive effect on my life. But after this? I think I might just have to stop reading anything of yours simply out of solidarity for my trans friends. I don’t really like the idea, I’d like to keep reading, but I think I might have to.

    And before you start to think otherwise, it’s not because you question the idea that being transgender is primarily biological. I don’t mind that questioning, I think it’s good to question everything. I think it’s okay for people to have different conclusions than I do regarding what is nurture vs. what is nature. In fact, reading your stuff has caused me to question a lot more things, transgender phenomenon included. Gender identity can certainly be fluid throughout people’s lives, which suggests it’s more psychological than we might think. That’s fine.

    What’s *not* fine with me is the way you’ve done it and how little awareness you’re showing of the effect that these words, as you’ve written them, can have. Us so-called “politically correct” folks don’t, I think, really care about what causes gender dysphoria anywhere near as much as we care about the right of individuals to not be dehumanized, shunned, denied the ability to live or subjected to neglect (as children), violence and murder. The idea that having a gender identity that doesn’t match your body is NOT a “brain sickness” has, correct or not, helped to gain these people some serious traction in that regard.

    Even IF you’re completely right in this…how can you be so sensitive to the ways that narcissists and psychopaths are unfairly scapegoated and hated and not show some awareness for how we massively do the same thing with people dealing with much more benign sex and gender-related issues?

    It seems a primarily contrarian move to me, and I’d ask you to question whether it might be. Also, saying, “At the risk of offending (people who I am currently insulting in the choice of words I use to refer to them),” is a wee bit gaslighty if meant in earnest. I hope it was merely meant as a pure, facetious insult.

    You have, it seems to me, something of a chip on your shoulder regarding the medical psychiatric establishment. I can certainly respect your reasons for this, but you need more to back it up than your hypothesizing and observing , intelligent though it is (and it is very impressive). A single anecdote is not data. It is very possible, I think, that there is biological transgenderism AND the phenomenon you describe. You do not have anything near the scientific and theoretical backing to be able to put such a potentially harmful idea out into the ether in such a cavalier manner, in my opinion.

    I feel fortunate right now because I very nearly sent a trans friend in the direction of your blog this very morning! I thought it would help her with some of the difficulties she’s facing, but I shudder to think how she would have reacted in seeing this post first, or how that would have affected my friendship with her.

    Thank you for reading this critical post. I hope it comes across in a respectful manner in spite of how much exception I’m taking.

    • Joseph Burgo says:

      Your comment is exactly what I was referring to by the politically correct thought police. I see your point about my choice of the phrase “at the risk of offending,” but from there you go off on a long angry tirade about people being dehumanized, shunned, physically assaulted, etc. Huh? What I said was that believing one is born in the “wrong” body is an illness, not that these people should be persecuted. You say that one anecdote doesn’t constitute data, but at the same time, you state your belief that there IS such a thing as biological transgenderism without any data to support that belief. There is no scientific evidence whatsoever, only statements of belief and personal testimonials. This is a grave mental illness, and like everyone else with a mental illness, these people deserve sympathy and professional help. I have no illusions about how much trans people suffer, and I feel badly for them. They deserve to be protected. But that doesn’t change the basic scientific facts. Unfortunately, the trans community has now entered the realm of identity politics where even to question their wrong-body belief sets you up for attacks like this one.

      The type of political correctness you espouse is the religion of the left and you use the same tactics as religious conservatives on the right by taking everything to the extreme and attacking the person who disagrees with you. The very idea that you would discontinue reading my blog, one you have found very valuable until now, because of my views says it all.

      • Lauren says:

        ” I see your point about my choice of the phrase “at the risk of offending,””

        Thank you for that.

        Hmm…there seems to be a lot of misunderstanding happening here about what I’m saying, both the general perspective and the specific points. I’m not sure that there’s anything I can do to clear that up…

      • Maddy says:

        I didn’t read Lauren’s response as an “angry tirade”. Perhaps I read it in the wrong voice? Your reply however, seemed like you were quite upset, but then again, perhaps I read it in the wrong voice.

        There are probably people who self label as Trans who fall into the category you describe in this post, because we are after all just people and our mental health is as diverse as the cis community’s.

        I think the sin of your post isn’t your hypothesis, it is simply your failure of understanding in how sensitive most people in the trans community are to being told our gender claims are incorrect or inaccurate.

        While you personally may be a proponent of equality, and may hold anti-discrimination views, your post is potential ammunition in the guns of those who attack the trans community. That is not to say science should abstain from asking these questions, rather people who hold degrees in science should be more understanding and sympathetic to those who are likely to be effected by the choice of words used when explaining the scientific endeavor.

        Gender Dysphoria is most likely a broad term used to cover multiple biological and mental processes which have similar symptoms. In some cases of GD there may indeed be a mental illness that needs to be addressed, it is perhaps an event early in life that leads to GD without mental illness, while in others it may be a less understood biological process that determines gender as separate from biology.

        These are fascinating avenues of research, however as we in the trans community are a marginalized group, discriminated against, targets of violence, ostracized, and have extremely high rates of self harm, it is not simply a matter of politics or politeness that should cause you to be more sensitive. It is rather a sense of compassion for humanity that should drive you to be more sensitive when discussing this topic in the future.

        -Maddy Love
        A Minnesota Trans-Atheist podcast
        http://www.tinyurl.com/stitchertrans
        http://www.trans-atheist.net

        • Joseph Burgo says:

          Thanks for your thoughtful, reasonable reply to this post.

          I understand your concerns, but does being more “sensitive” mean I should conceal my views because somebody else might mis-use what I say? My discussion seemed pretty respectful and straight-forward, accompanied by a compassionate portrait of someone I was able to help. I personally think it’s a tragedy that many unhappy young people are persuaded to believe that hormones and surgery are a viable approach to dealing with their pain. The only way I can address this is by offering a different perspective, and it surprised me, as I took a look around, that no one seemed to be discussing the trans phenomenon as a problem of displaced shame. To describe it as such (at least to me) is neither disrespectful nor insensitive — merely accurate from my perspective.

          If someone is delusional, having visual hallucinations, and hearing voices, we refer to him as psychotic and we view his condition as a mental disorder. By identifying it as such, we can then try to help him with an appropriate intervention. Ignorant, insensitive people will always stigmatize and persecute such people but we won’t help the “victim” by colluding with his belief that he is the Czar of Russian. I am NOT equating transgendered individuals with psychotics; I’m only trying to illustrate the advantages of accurate description as a prelude to providing help.

          • Maddy says:

            “but does being more “sensitive” mean I should conceal my views because somebody else might mis-use what I say?”

            Yes and no. No, because we should all have the ability to share our opinions and beliefs in a open forum. On the other hand, because you have a Phd, your opinion is automatically weighted more heavily than someone such as myself. When presenting, supporting, debunking established science in your relative field this is fair and necessary, and sensitivity towards the topic often needs to take a back seat to the current scientific understanding. However, when you are simply sharing an anecdotal story on the internet, which does not have scientific consensus, your Phd gives your anecdote a disproportionate weight compared to its scientific legitimacy.

            There are many in our culture, who will take a post such as yours and hold it up as a rationale for denying someone like me equality, while claiming they backing from experts (you). I realize that is not necessarily your intent.

            Perhaps it is also unknown to you that many in the trans community do not opt for HRT or surgical procedures. Some opt for HRT only, some have only “top” surgery. For many of us it is not a hatred of our bodies, that is a misconception by many outside of the trans community. Rather we simply want to bring our outer selves in line with who we are. If there is shame involved, it seems it would be more likely to be a motivating factor in keeping us in the closet rather than driving us out. Anecdotally that was the story in my situation.

            It wasn’t shame of not being enough of a man, it was shame of acting how I wanted to act because the group I was labeled with (male) was not supposed to act that way (feminine).

            Please be more careful with your words, please understand that if you truly care about the transgender community (and believe us to be suffering from a yet undiagnosed mental illness) you will be sensitive to the publics perception of us. Nearly all of us simply want to live in a world where our acceptance is not hindered by our gender or biology.

            -Maddy

        • Gordon says:

          If transsexuals are so sensitive I would recommend they don’t come on the internet. The internet in general is a harsh place.
          DISCLAIMER: I am not in any way saying they should not be allowed on the internet or that i don’t want them on the internet.
          Unrelated: Gender Dysphoria sounds like a perfume name to me.
          DISCLAIMER: I am not making fun of Gender Dysphoria and recognize it’s a serious condition.
          META DISCLAIMER: My use of disclaimers for satirical purposes does not negate or alter the contents of said disclaimers.

    • MJ Hutchinson says:

      I thought Lauren’s response was very respectful and provided some good feedback.
      I was blown away and surprised by what seemed like a super defensive response by Joe. Wow! And just for the record, I despise the politically correct thought police and did not even get a whiff of that in Lauren’s post.

    • Peter says:

      I actually read it as him stating his views with no insensitivity towards transgendered people at all?

      Funny thing though, as I was reading it I felt like I was bracing myself for an attack like yours. I knew it was coming. I would put myself on the ‘left’ more than on the right on the political spectrum as I can’t stand those far right fanatics who attack as soon as you question, but also have come to realize that yes, my friends on the left also attack in the same way when you question and I am able to call that out as a flaw.

      I didn’t read anything wrong in what he said nor did I feel he was making them out to be inhuman or degraded in any way. After reading the article I felt that he was saying that they have a ‘brain sickness’ (as you put it) in the same way we all do, making them like one of us.

      I felt like your reply was akin to a politically correct knee-jerk reaction. One I see in many of my leftist friends (and my right winged amigos when questioned) which is aggravating to me.

  3. a reader says:

    I happened to see an old episode of The twilight Zone the other day, which was in stark contrast to the urge for bettering or changing the way one looks. The film, “Number 12 Looks Just Like You”, was set in a future where everyone in their youth had to undergo an operation to have a perfect appearance, but the heroine, who looked very plain, had no wish to become a perfect beautie. She spoke wisely in defence of remaining the way she was, and fought against the operation.

    Nice to have you back, after your long absence, Joe!

  4. Denis says:

    It’s not a surprise that a heterosexual male therapist allows himself to categorically smash everything into the shame category, even transgenderism. I am very sure there do exist enough transgender people who had loving and caring parents and were brought up in the best way posssible. So your theory seems a bit to easy for me. Gender Identity is a very complex topic, so why someone would like to present the “core” of transgenderism in one small blog entry seems a bit strange to me and disrespects people who are transgender and are trying to find some light in this very foggy tunnel called “psychology”. They dont have it easy, not only because they are transgender but because they have to read statements like this and think of themselves as less mentally “sane”.

    • Joseph Burgo says:

      An ineffective argument is one that levels its criticism at the other person rather than his argument. This is referred to as an ad hominem attack, and for the politically correct, it is enough these days that I am a man. If you’d like to present any evidence to dispute my point of view, I’ll be happy to approve your comment. While you say that that you are “very sure” about what you believe, it’s still a belief; at least I have some experience in this area, as limited as it may be. I’m also able to extrapolate from 30+ years experience working with many people, men and women, who have struggled with their masculinity or femininity, even if they weren’t trans. Gender identity, I agree, is a complicated issue. What I’m disputing is the unfounded belief that some people are born into the “wrong body.”

      • Lauren says:

        What you can’t dispute is that some people are born into a body that is indeterminate as far as sex goes. Others are born with a sexual orientation that doesn’t match their body. We know that you can’t simply give a male baby a sexual reassignment at birth and raise him as a woman, or visa versa, so this would strongly seem to indicate that the brain has a gender, or at least, a gender continuum. With all of these facts, it seems fairly obvious to me that the MOST likely conclusion is that nature doesn’t always get it right in the brain just as she doesn’t get it right in the body.

        And if the brain DOESN’T have an essential gender…who are we to say that it’s more healthy to identify as a gender that matches your body? Shouldn’t we all be striving to see gender as purely a matter of the body? Why would it be more unhealthy for a man to suppress and reject his masculine side than his feminine side?

        • Dolma Beck says:

          Lauren, even though you have said you were leaving, I
          Still would like some clarification. Maybe someone else could help here. When you say, ” and if the brain, doesn’t have a gender”, what exactly do you mean by that? From a very young age, I would have seen my vagina/ my brain would have absorbed this perception.. My body is connected up. What of the hormones, pulsating thru my body, do you think they stop at my neck- not interact thru my whole biological system?
          ” who are we to say, that it’s more healthy to identify as a gender that matches our body”.. Now, it’s getting into the realms of the bizaar.
          I could call myself a frog, but my body( brain included), bled every month for many many yrs. It carried small creatures that grew and grew, till the time came for them to be expelled thru my vagina. Which magically, opened wide enough to let that happen. Then, again, magically, my nipples started secreting this milk type substance.. That these little creatures( small people, of course, 6 of them. 5 with penises. One with a vagina) latched onto- and gained sustenance from. All this, done without my brain being involved?
          I am not in any way, a traditional feminine woman. Always felt men had a better deal( in the 50s , when I grew up- in many ways they did). Identified more strongly with my father. An intelligent, artistic man. So, I’ve developed those parts of myself.
          Have I identified myself as my gender or has my gender( by it’s amazing abilities), identified me?

      • Jen says:

        It’s interesting that you take the comment on your being a heterosexual male therapist as an ‘ad hominem attack’. I often see this disconnect happen in similar debates. Is it possible to accept that our demographic circumstances afford us a likely range of experiences, and with that, a likely range of perspectives? Hence, ‘no surprise’. Are you sure this is an attack? To me it seems like an invitation (to you and your readers) to consider how those predispositions might be informing the views that you have, to question them from that perspective. Are you sure that couldn’t be a constructive line of inquiry? Does it require defence?

  5. ” that smelly black festering wound in her body”.
    Wow. A few months off, and look what you put out there.
    Powerful image. Strong post.
    I feel like I identified more with my dad when growing up. He seemed so much freer, not so convoluted and unkind as my mother. Never to the point where I wanted to have a penis..
    I went to a catholic school, where lesbian energy was insidious to the whole place. Totally off point here, I know. Maybe it’s just the continuum of all our sexual identities expresses in so many many ways.

  6. klem says:

    Whew. . .passion and intensity lit….the stuff of life!

  7. Kim says:

    While I cannot really comment on Gender Identity disorder I certainly relate to body dysmorphia and can see how these two things could be related. I have always felt ugly and fat no matter how I look on the outside and these “feelings” are absolutely resistant to verbal reassurances from other people about how good or thin I look (because I think the “feelings” were acquired pre-verbally). I can also go into a tailspin of shame and self hate when I look at any picture of myself that has just been taken (God forbid someone should take a video). I have a good 2 year wait time until I can look at a picture of myself and be somewhat objective. I am old enough now and have had enough self examination that I “know” on some level that these are distortions and that in some ways this behavior is incredibly selfish (it’s always about me, me, me). But I still suffer on a daily basis with this basic shame. And the word shame does fit. Hating your own body and everything about it is an incredibly painful experience and it is very seducing to think about escaping the pain through manipulating and changing this hated flesh. I have found diets and weight loss always bring some temporary relief but never permanent. The shame and hate always sneak back. It also does feel very pre-verbal to me. Yeah, my mom blah, blah, blah (you know, really bad mom-no loving reflection there). Therapy has helped lots and I feel I am at a critical point in therapy right now around this. I have realized how much the intimacy (emotionally) of the relationship with my therapist has triggered feelings of pure anxiety and fear and shame because my child and infant brain just react that way when relationships try to become intimate. I am trying to hang in there and my therapist says that if I can feel some emotion in session with him related to this pre verbal anxiety and fear and shame and I can have a different experience inside therapy, then some healing can occur and I can get some relief. I have finally come to this point after many years of therapy. Trust did not come easy. However, I wanted to know if this rings true to you Dr. Burgo. Is this one way therapy can heal some of these very early wounds? If I can manage to be brave enough to follow through?

    • Joseph Burgo says:

      Kim — I absolutely agree with your therapist and I think you’re fortunate to have found someone who works/believes the way he does. Everything you have written rings true. I wrote about the possibility of healing in this earlier post.

      • Kim says:

        Thanks! I read the earlier post and have read it before. It is amazing how the emphasis and meaning of things change when you read them at different points in time.

  8. Sheila A says:

    Do you remember that old episode of Star Trek where Kirk visits this desolate planet (weren’t most of them? lol ) and the women were strikingly beautiful, but they were only so if they took the “magic” pill – otherwise they were horribly disfigured. I can’t remember the entire conflict of the story but the resolution was that Kirk had given this one particular woman a placebo and she was beautiful – moral of the story was that beauty is still on the inside – it’s how we view ourselves that reflects on the outside – or so it goes.

    Personally, I am not surprised in today’s commercial world, that people are having such difficulties accepting who they are and how they look. We get glimpses into the lives of the superstars and think that because they look so beautiful that their lives must be perfect too. Ya, right! People so often think that celebrities have it all – well, fame and fortune does come at a very high price. It’s a complicated problem with so many people. “If I could just look like so-&-so, if I just had so&so’s fame, or money or talent” We live too much in the world of other people rather than looking inside to find the beauty that lies within. There is no secret pill to take to change our outside packaging. No one can make our lives perfect – that’s not reality, and that’s a problem.

    And I’m not even going to touch the gender part of the conversation :)

    Welcome back, Joe

    Sheila

    • Joseph Burgo says:

      I DO remember that Star Trek episode! One of my favorites. And yes, you’re so right about the problem of accepting how we look in our commercial world. So many people have a hard time accepting that they are just who they are and that there’s no “magic pill,” as you say.

  9. Jul says:

    Hi Dr. Burgo,

    I am as politically uncorrect as one can be, but I still think that your theory regarding gender identity disorder as a subtype of body dismorphic disorder is wrong.
    Just look at the complicated processes inside a pregnant woman’s body that determine fetal development and all the possibilities of something going wrong. Wrong hormones in the wrong dosage at the wrong time. Or all the things that can go wrong on the chromosomal level that may lead to a child being born as a hermaphrodite.
    I do understand that hermaphrodites are not the same as transgender people, but the very fact that they exist should suggest to anyone who cares to look at this fact that mother nature is not black and white, that there is a huge grey zone.
    If the existence of people without a clear sex is possible, than why shouldn’t it be possible that people exist without a clear gender identity?

    • Joseph Burgo says:

      Good points, and I agree about hermaprodites being a different subject altogether. I also agree that things can go very wrong on a hormonal level, leading to painful confusion about who one is gender-wise. To my mind, though, that would lead to a lot of shame, (a feeling that things have gone wrong development-wise). While it would be agonizing to feel this mismatch, it doesn’t follow that it can then be surgically/hormonally corrected. I’m heartened by the fact that, as a society, the strictly binary male-female role models seem to be breaking down and that it’s becoming more and more acceptable for people to diverge from stereotypic gender identities. That’s why I object to the “born in the wrong body” approach, where the “solution” is to go from black to white. Why not accept that you are gray and don’t fit into any clear-cut gender category?

      On a factual level, gender is defined by your chromosomes: XX = female, XY = male. Due to an abnormality such as adrenal hyperplasia, hormones may cause the genitals of a person with XX chromosomes to appear masculine, but that doesn’t make her a man. Nor can she ever become a man. Due to her genetic makeup, it’s not possible.

      • Martin says:

        Gender is not defined by chromosomes. Gender is social identity with contextually understood roles. What we call sex, the bodily distinctions we make based on mostly biological criteria, is often currently defined by chromosomes, but not easily as you may think. Let me give a quick history:

        We defined sex very differently over the hundred years. Early 20th century thinkers thought sex was determined by gonads and hormone producing organs. If someone had testes, their bodies were labelled male and if they had ovaries, their bodies were labelled female. This was done even if external genitalia did not seem to match up in the typical fashion and “problems” arose because it was not always easy to tell what were testes and what were ovaries (ex. undescended testes look really similar to ovaries).

        Midcentury, a switch was focused to determining sex by the appearance external genitalia. If someone had a penis, their bodies were labeled male (and gendered as a boy). If someone had a vagina, their body was labelled female (and they were gendered as a girl). This also was not so clear (ex. penises/clitorises aren’t always so easy to distinguish, some male bodies are born with undescended tests and incomplete scrotums which would look like labia, etx.). This led to a lot of cosmetic sex assignment surgeries on intersex children to try to make their external genitalia look more typical, and often took the form of trying to make the appearance of female genitalia (it was believed it was surgically easier and less intensive because it involved more removal of parts than grafting.)

        Closer to the turn of the century when we had more advanced understanding of genetics, we began to look at chromosomal differences to determine sex. Folks with XX chromosomes were sexed as female, and folks with XY chromosomes were sexed as male. This is an incomplete story, however, because there are a lot more potential chromosomal configurations, like XXY that many people have (folks with this configuration often present more typically as male). I question your use of this approach to sexing in your response, as someone who seems to be against “binary” systems of sex/gender, it seems like binary reductionism to assert XX=woman and XY=man.

        In all, sex is not so easy to determine and is subject to social and historical contexts as much as gender is. It is also does not have to be associated closely with gender or sexuality; our western gender-sex-sexuality paradigm (two kinds of bodies, two associated genders, with unidirectional heterosexual attraction, and knowing one factor will tell you the other two because they are so correlated ) is unique and relatively recent understanding of how bodies, genders, and sexualities interact, and is not consistent with understandings from other times and cultures.

        To further a counterview, if you believe like the psychiatrist you linked in the article and given that we now know that chromosomes are not the exacting determinates of sex that we may have thought , that male bodies (and hence men by his narrow definition) are defined by their ability to produce semen and female bodies (and hence women) by their ability to gestate and nurse children, are men who cannot produce semen or women who cannot get pregnant not men and women? I think that would be a more contentious argument to push than that people’s bodies and genders do not have to conform so social norms.

        • Joseph Burgo says:

          “I question your use of this approach to sexing in your response, as someone who seems to be against “binary” systems of sex/gender, it seems like binary reductionism to assert XX=woman and XY=man.” I take your point and will reconsider my view. What it seems to come down to is that gender and sex and much less clear-cut than we think, with lots of gray area between. Which only goes back to my point about choosing one versus the other.

          • Martin says:

            I am going to pose hypothetical and somewhat sarcastic questions:

            What if a cisgender woman had a mastectomy because of breast cancer. Does her lack of breasts mean she be less of a woman?

            What if she decided to get reconstructive surgery, her stated purpose to make her feel more like herself . Would it be a sign of mental illness for wanting such an procedure? Does she not know that the surgery will not give her “real” breasts and would damage her body? Is she in denial for some core shame and responding to it by taking it out on her body?

            Should she go through two years of mandatory therapy before having such a procedure?

            Is performing the operation colluding with a mental illness? Is the only “healthy” decision she could make to live with her body as is?

            Ok.

            Now let’s replace that cisgender woman with a transgender woman. Instead of the trauma of breast cancer and a mastectomy, she has had the trauma of years of people denying, invalidating, ridiculing, and threatening her sense of self .

            She may not have breasts like other women, but is she less of a woman because she doesn’t have them?

            If she wanted to have top surgery, her stated purpose to make her feel more like herself, would that desire be a sign of mental illness? Doesn’t she know that the surgery won’t give her “real” breasts and would damage her body? Is she in denial for some core shame and responding to it by taking it out on her body?

            Should she go through two years of mandatory therapy before having such a procedure?

            Is performing the operation colluding with a mental illness? Is the only “healthy” decision she could make to live with her body as is?

            Ok.

            Can you tell me substantially what the difference is between these women? Can you do so without relying on existentialist notions of sex and gender?

            Is one woman healthier than the other?

            • Dolma Beck says:

              What exactly is a cisgender?
              Martin, something about this comment of yours I find really distasteful. Women who loose a ( real) Breast to cancer- haven’t chosen for this to happen.
              A transgender, chooses to have a Breast attached..

              • Martin says:

                “Cisgender and cissexual (often abbreviated to simply cis) describe related types of gender identity where individuals’ experiences of their own gender match the sex they were assigned at birth” – Wikipedia

                I think that’s a fair definition. For example, if you were labelled female at birth because of what your body looked like, and you also late identify as a girl/woman, you are cisgender. It’s a complimentary term to transgender, where we can actually name people who we tend to just view as normal. By not only naming/labeling transpeople, we create a language that makes transfolk deviant and cisgender folk “normal” and hidden from scrutiny/observation.

                I mean no distaste. My point is that I don’t see much difference, transwomen didn’t choose to not have breasts, either. Would it seem less distasteful if I changed the analogy to a cisgender woman who had a a preventative mastectomy because of genetic predisposition to breast cancer but has never had cancer?

        • Jacob says:

          I am in the process of writing a research paper, and came across this website. I recognize I am late to the discussion, but I wanted to address the argument Martin makes.
          Martin, I will begin by stating I was very concerned someone might read what you’ve written and inadvertently believe there is an ounce of truth in it—versus this being your own set of opinions. The argument you make is based on your need to believe your own ideas, and is not supported by research or facts. You make-up historical timelines and context throughout your argument; my notes are as follows contained in [[ ]].
          “Gender is not defined by chromosomes. Gender is social identity with contextually understood roles. What we call sex, the bodily distinctions we make based on mostly biological criteria, is often currently defined by chromosomes, but not easily as you may think. Let me give a quick history:” [[first let me say, your need to appear to be educating readers is an interesting tone to set considering the statements you make in your rebuttal are not supported.]]
          We defined sex very differently over the hundred years. [[Over which hundred years do you refer?]] Early 20th century thinkers thought sex was determined by gonads and hormone producing organs. If someone had testes, their bodies were labelled male and if they had ovaries, their bodies were labelled female. This was done even if external genitalia did not seem to match up in the typical fashion and “problems” arose because it was not always easy to tell what were testes and what were ovaries (ex. undescended testes look really similar to ovaries). [[First off, gender is identified in all civilizations; since humans began recording their experiences. All religious text (the Koran, the Torah, the Bible, ect.) identify men and women. Where you got the idea identifying genders has been open to debate for long spans of time is your creation, and not based on facts. You then generalize that it was difficult to tell if someone was born with testes. Stating it was not “always” easy? You would need to indicate who this has been a problem for. What recorded evidence do you have that states most individuals are born with ambiguous genitalia, and that these occurrences are not merely anomalies? Statistical evidence puts those born with ambiguous genitalia in the vast minority biologically. ]]
          “Midcentury, a switch was focused to determining sex by the appearance external genitalia.” [[You state there was a “switch,” “mid-century.” A switch from the early 20th century from your claim above? By your timeline, that brings us to about 1950. You are claiming the medical community decided to begin assigning gender based on the appearance of external genitalia—in 1950. Gender was identified by the appearance of external genitalia for vast spans of time proceeding 1950. Please understand this again is your creation. It’s extremely fanciful, but I would wonder why you feel entitled actively distort history.]] “If someone had a penis, their bodies were labeled male (and gendered as a boy). If someone had a vagina, their body was labelled female (and they were gendered as a girl). This also was not so clear (ex. penises/clitorises aren’t always so easy to distinguish, some male bodies are born with undescended tests and incomplete scrotums which would look like labia, etx.).” [[Again, you are aggrandizing a biological anomaly and asserting it is common place. It is as common as a gorilla falling through the roof of your house. It seems you are struggling to make it appear gender is ambiguous and open to interpretation--but again this is only your belief]] “This led to a lot of cosmetic sex assignment surgeries on intersex children to try to make their external genitalia look more typical, and often took the form of trying to make the appearance of female genitalia (it was believed it was surgically easier and less intensive because it involved more removal of parts than grafting.)” [[No such thing has happened. There have not been “a lot” of cosmetic sex assignments performed on children. This is statistically rare.]]

          “Closer to the turn of the century when we had more advanced understanding of genetics, we began to look at chromosomal differences to determine sex.” [[You have now jumped back in the timeline to 1900. You are stating in 1950 individuals were determined male/female by their genitalia, you are now claiming 50 years earlier civilization gained a more advanced understanding of genetics and began classification based on chromosomal differences. You are giving the impression of making this argument up as you go—the argument shows a basic lack of logic]] “Folks with XX chromosomes were sexed as female, and folks with XY chromosomes were sexed as male. This is an incomplete story, however, because there are a lot more potential chromosomal configurations, like XXY that many people have (folks with this configuration often present more typically as male). I question your use of this approach to sexing in your response, as someone who seems to be against “binary” systems of sex/gender, it seems like binary reductionism to assert XX=woman and XY=man.” [[There is no such thing as “binary reductionism.” Again this is your creation. There exists a binary decision diagram, and is a reference to the mathematical paradigm based on the Boolean function. But if this was what you had meant, I would think you would have just said that, rather than make up another word.]]
          “In all, sex is not so easy to determine and is subject to social and historical contexts as much as gender is.” [[The problem here is you personally decided it was not easy to determine, you have presented no evidence to support this claim.]] “It is also does not have to be associated closely with gender or sexuality; our western gender-sex-sexuality paradigm” [[This is not, nor has it ever at any time been a determination based on geography. People identify gender in Kuala Lumpur just as readily as they do in the United States.]]
          “(two kinds of bodies, two associated (Two things connected) genders, with unidirectional (moving in the same direction) heterosexual (attracted to the opposite sex) attraction, and knowing one factor will tell you the other two because they are so correlated )” [[You have said: two connected genders, moving in the same direction, attracted to the opposite sex, and knowing this will tell you the other as they have a mutual connection. Word for word what you wrote. You have literally said nothing here with the most vocabulary possible. The words are not even organized correctly so that your thought was clear.]]
          “is unique and relatively recent understanding of how bodies, genders, and sexualities interact, and is not consistent with understandings from other times and cultures.” [[The problem with your argument is that you took a very basic thing, convoluted it, made up evidence, and then concluded it was confusing. You are only giving the impression that it is confusing for you.]]
          To further a counterview, if you believe like the psychiatrist you linked in the article and given that we now know that chromosomes are not the exacting determinates of sex that we may have thought, that male bodies (and hence men by his narrow definition) are defined by their ability to produce semen and female bodies (and hence women) by their ability to gestate and nurse children, are men who cannot produce semen or women who cannot get pregnant not men and women? I think that would be a more contentious argument to push than that people’s bodies and genders do not have to conform so social norms.

          Martin, your method of communicating in a convoluted, unsupported, grandiose, illogical, and contradictory fashion in order to argue a point you actually don’t understand is typical of narcissistic individuals. You make statements created out of your own imagination and do so in such a condescending way, it is easy to see you feel you are arguing from an inferior standpoint. You obviously do not have an education level to support the reasoning you are attempting, but you evidently have gotten away with this kind of bulldozer logic with weaker individuals in your life. If you feel others need to be open to critics on their reasoning, remember you are subject to the same scrutiny.

          • Martin says:

            Jacob, let me take a little time to respond to your criticism directly. Below I have copied your notes and written some responses. I preemptively apologize if the editing is not perfect.

            1 – [[first let me say, your need to appear to be educating readers is an interesting tone to set considering the statements you make in your rebuttal are not supported.]]

            My goal was primarily to engage Joe. If I were trying to educate readers, I would have my own blog. Responding to his blog post in the comments section to me felt like the most efficient way to respond to the blog post.

            2 – [[Over which hundred years do you refer?]]

            I meant over the LAST hundred years. My timeline is roughly 1900 to the present. I see how this is confusing. I apologize for the poor editing.

            3 – [[First off, gender is identified in all civilizations; since humans began recording their experiences. All religious text (the Koran, the Torah, the Bible, etc.) identify men and women. Where you got the idea identifying genders has been open to debate for long spans of time is your creation, and not based on facts. You then generalize that it was difficult to tell if someone was born with testes. Stating it was not “always” easy? You would need to indicate who this has been a problem for. What recorded evidence do you have that states most individuals are born with ambiguous genitalia, and that these occurrences are not merely anomalies? Statistical evidence puts those born with ambiguous genitalia in the vast minority biologically. ]]

            I will say that you don’t seem to understand the distinctions I have made between gender and sex. I’ll use wikipedia’s definition of the difference – “Sex, the biological makeup of an individual’s reproductive anatomy or secondary sex characteristics…[G]ender, social roles based on the sex of the person (culturally learned) or personal identification of one’s own gender based on an internal sense of gender (gender identity).” -http://en.wikipedia.org/wiki/Sex_and_gender_distinction

            This particular response was about challenging how “fixed” our notions of bodies are and what constitutes male and female bodies. Joe was asserting that bodies are pretty simplistic/rigid, but gender is fluid. I was arguing that even just over the last century, the way we think about bodies has also had fluidity, and it is not as easy to anchor genders onto stable notions of bodies as he thought. He later agrees with me in this regard to some extent.

            I agree with you that nearly all civilizations have genders. What those genders mean for people are not always the same and across time and culture we have seen very different ideas of genders. Gender roles – occupations, dress, language, sexual behavior, etc. can be very different. Some civilizations recognize more than two genders. For example, hijras on the Indian subcontinent and twospirits in some North American indigenous peoples. However, this is not particular relevant to this response as it was not about showing expansive notions of gender, but of sex.

            I also never said that most people are born with ambiguous genitalia. That some people are born with ambitious genitalia (or more broadly with bodies with any kinds of intersex conditions), however, I believe is enough to challenge rigid views of what sex means (ex. more than XX=Female and XY=Male). Data on intersex infants is not so readily available for all sorts of reasons (limited research interest, physician concealment, parent shame, etc.), but I’d check out the well-researched summary from the Intersex Society of North America at http://www.isna.org/faq/frequency. You might claim the organization has “bias”, but I don’t know what other organization would be more interested in having accurate data about intersex conditions. The relevant data pulled, for your reference, are “Total number of people whose bodies differ from standard male or female – one in 100 births…Total number of people receiving surgery to ‘normalize’ genital appearance – one or two in 1,000 births.” This data was partly compiled by Anne Fausto-Sterling and expanded on in her book, Sexing the Body. I will also note that my argument was not based on ease of difficulty of “sexing” infants, but that different criteria has been used over the past century. This means that what we think of the bodies of a “boy” or “girl” has been open for discussion, and has changed, several times, in only a century.

            4 – [[You state there was a “switch,” “mid-century.” A switch from the early 20th century from your claim above? By your timeline, that brings us to about 1950. You are claiming the medical community decided to begin assigning gender based on the appearance of external genitalia—in 1950. Gender was identified by the appearance of external genitalia for vast spans of time proceeding 1950. Please understand this again is your creation. It’s extremely fanciful, but I would wonder why you feel entitled actively distort history.]]

            My goal was to offer a brief historical overview, not write a research paper. Let’s remember this is an anonymous response to a blog post ;-) . To be more clear, my timespan is intended to cover a period of time that approximates modern medicine.

            I drew my views from some of the limited scholarship available. I would point you towards Alice Dreger’s Hermaphrodites and the Medical Invention of Sex (Harvard University Press, 1998) as a great resource. (Note hermaphrodite is a rarely used term now and often considered offensive, but was the term in use for the time period she writes about, roughly 1870s-1920s). Her history is infinitely more robust than mine, particularly in regards to all of the theories that had cache in the late 19th century and early 20th century.

            By midcentury, I am referring primarily to work of the physicians who established the John Hopkin’s Sexual Behaviors Consultation Unit (SBCU), in the 60s and early 70s (John Money and ilk). It is this unit that developed the standards for care of intersex children and the theories that underpin them that reflect their understanding of all infants. Basically, they believed babies did not have genders, so regardless of other sex-related characteristics (hormones, internal sex organs, genes, etc.) if external genitalia were not typical, children would have “confused” genders. They could prevent this by engaging in aggressive surgeries to make genitalia look more typical of what we know as male and female, and then raise the children with the corresponding gender (boy or girl). As it turned out, kids raised in this fashion had a lot of confusion because their doctors and parents were secretive about what was happening. Additionally, kids with typical looking genitalia who nonetheless had other intersex conditions (ex. atypical genetic configurations) were rarely made aware of such conditions, which would help them understand changes in their body that might occur later in life.

            There is some interesting scholarship that is more cross-cultural in focus as well as some that cover less recent history as well, and would be happy to provide you some citations if you are interested.

            5 – [[Again, you are aggrandizing a biological anomaly and asserting it is common place. It is as common as a gorilla falling through the roof of your house. It seems you are struggling to make it appear gender is ambiguous and open to interpretation--but again this is only your belief]]

            Again, I am not talking about gender, but about sex. I am arguing that sex is not as simple as XX=female and XY=Male, and that this has implications for our understanding of bodies, gender, and identity. I would not make claims about how commonly gorillas fall through my roof without knowing where I live.

            6 – [[No such thing has happened. There have not been “a lot” of cosmetic sex assignments performed on children. This is statistically rare.]]

            I don’t believe rarity has much implication for my argument. I believe there have been lots of cosmetic assignment surgeries performed on children, again, check out the Intersex Society of North America for more information and documentation. In my previous citation, it is estimated that .1-.2% of people have surgery to “normalize” their bodies. I would guess that this would be a low estimate due to the fact these surgeries are often secretive and shame-ridden on the parts of doctors and parents. Regardless, using this estimation, hundreds of thousands of people in the US have had such coercive surgeries.

            7 – [[You have now jumped back in the timeline to 1900. You are stating in 1950 individuals were determined male/female by their genitalia, you are now claiming 50 years earlier civilization gained a more advanced understanding of genetics and began classification based on chromosomal differences. You are giving the impression of making this argument up as you go—the argument shows a basic lack of logic]]

            By turn of the century, I meant turn of the 21st century, roughly the two decades preceding 2000. I am not claiming that folks in the early 1900s had a more sophisticated understanding of genetics than folks later in time.

            8 – [[There is no such thing as “binary reductionism.” Again this is your creation. There exists a binary decision diagram, and is a reference to the mathematical paradigm based on the Boolean function. But if this was what you had meant, I would think you would have just said that, rather than make up another word.]]

            By binary reductionism, I mean pretty literally reducing complex concepts (ex. sex or gender) to two binary components. Joe and I both agree that gender or gender identity is not a stable concept held together by easily described notions of masculinity and femininity, and I am trying to further the argument that sex isn’t either. Bodies come in more than two kinds. Our process of trying to fit bodies into two kinds is a contextual process that has changed and will continue to change over time.

            9 – [[The problem here is you personally decided it was not easy to determine, you have presented no evidence to support this claim.]]

            I have provided some data on this already, more than you had originally rebutted with.

            10, 11, 12 – [[This is not, nor has it ever at any time been a determination based on geography. People identify gender in Kuala Lumpur just as readily as they do in the United States.]][[You have said: two connected genders, moving in the same direction, attracted to the opposite sex, and knowing this will tell you the other as they have a mutual connection. Word for word what you wrote. You have literally said nothing here with the most vocabulary possible. The words are not even organized correctly so that your thought was clear.]] [[The problem with your argument is that you took a very basic thing, convoluted it, made up evidence, and then concluded it was confusing. You are only giving the impression that it is confusing for you.]]

            I’m going to combine these points together.

            What I wrote was an explanation of what I am calling the Western gender-sex-sexuality paradigm, the pervasive discourse that people come in “two kinds of bodies, two associated genders, with unidirectional heterosexual attraction, and knowing one factor will tell you the other two because they are so correlated”. So you have misquoted me in your notes for starters. Further, I am saying this paradigm implies sex, gender, and sexuality are all tightly correlated with each other. For example, people with penises will/should identify as men, they will/should exhibit “macho “ traits, and will/should be attracted to and have sex women. In this paradigm, if you know someone’s gender, sex, or sexuality, you can assume the other two without thinking.

            I believe that this paradigm is not stable, inherent, or good, and that it rightfully should be and has been problematized. Ex. We know that not all men are attracted to women, not all people with penises identify as men, etc. I take it that because you believe I “have literally said nothing here” when referencing the paradigm, that you find no problem with it. I certainly do, and so does Joe to an extent. I would also argue that we can look at cultures around the world and historically to find evidence that this is not a static paradigm, but greatly contextual. Other peoples configure sex, gender, and sexuality differently.

            I admit I am not a strong writer and that I obviously did not convey my argument in a way that was convincing to you. I also believe that these concepts/notions/paradigms often go unnamed and unanalyzed, making even thinking and writing and talking about them difficult. Many scholars are able to do this much better than me. That they are difficult to wrap our minds and words around doesn’t make them less important though.

            13 – [[Martin, your method of communicating in a convoluted, unsupported, grandiose, illogical, and contradictory fashion in order to argue a point you actually don’t understand is typical of narcissistic individuals. You make statements created out of your own imagination and do so in such a condescending way, it is easy to see you feel you are arguing from an inferior standpoint. You obviously do not have an education level to support the reasoning you are attempting, but you evidently have gotten away with this kind of bulldozer logic with weaker individuals in your life. If you feel others need to be open to critics on their reasoning, remember you are subject to the same scrutiny.]]

            Again, my brief history in the comments of a blog post was intended to be part of argument that sex, like gender, is a socially constructed concept, and cannot be reduced to simplistic, ahistoric (ex. genetic) certainties. I used this argument primarily to question Joe’s reliance on thinking of gender as fluid but sex as static, as that seemed a core part of his assertion that transpeople as a group had severe psychopathology. As this argument was directed at Joe, and he seemed to some extent agree, I have yet to understand your disagreement with my assertion. I am happy to review your arguments and evidence.

      • Rachel says:

        A little bit late to the party, but I thought I should mention that there are some intersex conditions such as complete androgen insensitivity syndrome (CAIS) where people are born with XY chromosomes but present as female in every way – physically, psychologically, etc. In CAIS, “genetically male” individuals are unable to respond to androgens, so they will develop as female, will look female, will think of themselves as female, etc. Many models have CAIS, because CAIS generally leads to a stereotypically feminine appearance and a lack of blemishes such as acne (since the body is unable to respond to testosterone). It is also worth noting that in other species, particularly fish and birds, XY chromosomes sometimes signify femaleness and XX chromosomes signify maleness (as measured by gonadal tissue, i.e. ovaries or testes).

        I would agree with your point that GID is not usually (or necessarily) as clear-cut as “being born in the wrong body,” but I think you will find that if you have contact with a large number of transgendered people, most of them don’t subscribe to this narrative. I work with an organization that advances LGBTQ rights, and I have met many, many transgendered individuals. Very few of them have histories of trauma, and a large number have decided not to have surgery (particularly considering the cost of such surgery).

        I would also like to mention a study conducted in 1995, conducted by Zhou at el., which found that the stria terminalis in the brains of FTM transsexuals is the same size as the stria terminalis in the brains of men and the stria terminalis in the brains of MTF transsexuals is the same size as the stria terminalis in women. Follow up studies were conducted in 2000, 2002, and 2008 that confirmed these findings, and found that they hold steady in pre-operative transsexuals who have never taken hormones or had any surgery.

        I agree with you completely that sex and gender are not as clear cut as we think they are, but I believe, based on academic research as well as the lived experiences of the LGBTQ people I work with on a daily basis, that this is largely because gender is primarily psychological. There are certainly biological components to gender, but there is nothing inherent in the brain of a “woman” that makes her behave in most stereotypically feminine ways (there is a multitude of academic research to support this assertion, ex. Preves, Dreger, Lorber, Kessler, Fausto-Sterling, Holmes, etc.). I would also ask why it is necessary to medicalize the transgender individual who desires to alter his or her body, particularly if altering his or her body or presenting him or herself as the “other” gender will resolve psychological distress. The majority of the transgender people I know felt distress prior to their transition and feel much more comfortable after their transition, particularly if they transitioned at a young age. So I would ask why it is necessary to pathologize this condition, especially if we are in agreement that gender and sex are fluid and much less rigid than most people think.

        If you are interested in learning more about this, I would suggest you read Anne Fausto-Sterling’s “Sexing the Body.” It’s very interesting and talks a lot about the construction of sexual and gender categories and the different conditions that may trouble those categories, ex. transgender and intersex conditions.

    • Joseph Burgo says:

      P.S. — Here’s a link to an article I found about transgender rights in Canada. The psychiatrist speaks to the lack of scientific support for the trans position and also considers it to be a psychological disorder, a kind of somatic delusion.

      http://www.lifesitenews.com/news/psychiatry-expert-scientifically-there-is-no-such-thing-as-transgender

      • s says:

        Dr. Burgo,
        Please, please, take a look at this source (ie: lifesitenews.com). It is a very biased outlet, with a clear political agenda. Please also look at the comments following this article that you posted. I think it would better to post a link to a peer-reviewed article on this topic.
        Best,
        S

        • Joseph Burgo says:

          I see what you’re saying. Such websites are repellent and clearly political. I’ll look around for an article, but one of the reasons I wrote this post is because NOBODY is writing about transgender in the way that I do, as far as I can tell.

      • Martin says:

        Reading the article, it is important to note that is published by an organization promoting what is often called a conservative, christian, “pro-family/life” agenda, and are admittedly not interested in an open discussion or full story. http://www.lifesitenews.com/about

        The photos used in the article are of men in drag at a pride parade. Dressing in drag (lots of cis-men queer and straight do so at pride parades) is not the same as identifying as trans. The article tries to make a conflation between any gender play and mental illness, something that Joe would probably disagree with, and do this to try build a political case against a anti-discrimination bill that includes gender identity and expression as protected classes.

        It is also an example of what was put forward as a worry here, that quotes from experts can be misused for political and arguably harmful purposes.

        I will also add an aside about Paul McHugh, John Money, and other mental health professionals at the Johns Hopkins Sexual Behaviors Consultation Clinic (SBCU) who are cited in this article. The SBCU pioneered, practiced, and exported the act of forced and coerciced “sex-assignment surgeries” on intersex children for decades. While I believe that people should have determination about their bodies, the same people who are now calling trans people sick for being trans are the ones who (still) without consent altered/damaged body parts of infants and children so that they, their families, and schools would be more comfortable with their bodies. Many of these children grow up with deep confusion about their bodies and how they worked, experienced very real shame because it was often policy that doctors/parents would not discuss what the surgeries were for, and lost a lot of ability for sexual pleasure due to the damage of surgery.

        I think it is deeply hypocritical and wrongheaded to purport being transgender is a mental illness but then cause iatrogenic mental illness because they can’t accept that like gender, bodies don’t just come in two exact kinds. If they don’t believe adults can make informed decisions about their bodies, then they should not be making those same decisions for children who cannot.

        Check out: http://www.isna.org/ for more info.

  10. Fiona says:

    Hi Joseph,

    Just want to say that I think you are spot on. I had a transgender boss who was a Narcissist (i realise now) and I’m sure that shame was at the core of her issues. I also had a lesbian friend who felt more male than female….sadly she committed suicide in her twenties …she definitely had a narcissistic mother.

    I am a lesbian who has little to do with the LGBT community precisely because of people like Lauren above.

    I feel so sad when I hear of young people( or indeed anyone) having very invasive operations to change their gender. In this country it’s compulsory to have counselling prior to the operation but I don’t think it can be of good quality (sadly). I’ve often wondered if they feel better after the operation(s) ? or if their problems return?

    • Joseph Burgo says:

      Fiona, There’s a lot of controversy about your latter question. Both before and after transition, trans people have exceptionally high suicide rates, as much as 9 times the national average per capita, but it’s unclear how much of that is due to the persecution and social rejection they experience. Search the term “transgender regret” and you’ll find a lot of resources that address your question.

  11. This is interesting and brave. However, if somebody is born with a facially disfiguring birthmark are their parents suffering from a neurosis if they can organise plastic surgery to remove the disfigurement? No society is so perfect that its members won’t react in a negative way with damaging repercussions on a child with the disfigurement.
    It’s not only individuals who have idealised images of physical perfection. Societies do, too, especially America where you live and work.

    • Joseph Burgo says:

      Isn’t there a difference between an actual, visible disfigurement like that birthmark and one that is merely felt as such?

      • I’m tempted to play ping-pong and ask another question, but I would risk becoming a patient trying to manipulate his therapist. My reaction to your reply was “this is difficult to get my head round” and I had a physical reaction of wriggling my legs and feeling hot and bothered.
        So. I guess a child who has a birthmark removed has to be brought up after the operation so that s/he knows about the operation, but isn’t made to feel shame about having had an operation. It’s tricky for the parents not to bring up their child with the feeling that they didn’t have some kind of physical “original sin” which MARKS them out. So my intuition is that the child might well run the risk of having the same issues as a person who feels they have the wrong physical body for the gender they believe they belong to. Probably my use of ‘feel’ and ‘believe’ can be challenged.

      • Jen says:

        Surely ‘actual, visible disfigurement’ is in the eye of the beholder? There are people who live quite happily with birthmarks, and those who prefer to have them changed. Yet although it’s perfectly possible to live in acceptance with the birthmark, you approve of a surgical approach. You seem to be saying that if society agrees that something is shameful, then it is, and it’s okay to correct that with surgery so that the individual fits in. Whereas if the shame or restriction in relation to social norms is carried only by the individual, and is invisible to society, surgery is an invalid and destructive option. This seems quite arbitrary.

  12. Anonymous says:

    Joseph,

    This article linked me to an earlier article that you wrote about shame (What I Mean When I Use the Word Shame). You mentioned in that article that you are writing a book all about shame. Did you finish writing that book, and can you tell me the name of that book?

    Thanks!

    • Joseph Burgo says:

      That books remains unfinished because the publishing world didn’t seem terribly interested. I subsequently sold a book about narcissism that will be released next summer. It’s all about shame, too, but approached from a different angle — through the narcissistic defenses against it.

  13. Thomas says:

    Dear Joe,
    To help with some context about your basis for these opinions, have you worked with more than a handful of clients with gender issues? (I’m assuming more than one, so you woukd be able to generate a composite, hypothetical client.) And have you kept up with developments in transgender health and mental health? One reason I ask is because you are using out of date language, particularly “Gender Identity Disorder” (from the DSM-IV). The current language is “Gender Dysphoria.” That’s not about being “PC,” but relates to the competence of your professional opinions in this matter.

  14. Rachel says:

    Regarding being transgender, more research is needed. We all have things we believe, things we know, and things we can prove. There are many things that scientists know, but can’t prove, that we can still debate, including global warming. (But, that is another topic.)

    We know that all human embryos start as female. We know that about week 11 the gonads begin to produce hormones. If the gonads produce testosterone, we know that the body is changed from female to male. We know there are several key body dimorphic attributes for human beings. Among these are the genitals, the anogenital distance, the elbow carrying angle, ring finger length, and the brain. We do not know all of the impacts of all of these changes.

    We also know that there are natural and man-made endocrine disruptors. We know that embryos exposed to some of these endocrine disruptors do not fully virilize.

    We know there are chromosomal differences that may produce human beings that are not stereotypically male or female. These individuals may be referred to as intersex. As stated in earlier comments, the intersex condition can occur in human beings with traditional 46XX or 46XY chromosomal makeup. The intersex condition can also result from 45XO, 47XXY, or 47XYY.

    Based on this evidence we know the following. The human brain is virilized by testosterone. There are natural endocrine disruptors, man-made endocrine disruptors, and chromosomal variation that can all adversely effect virilization. Therefore, these factors can adversely effect the virilization of the human brain. Further, we do not know the full impact of brain virilization. Therefore, we cannot know the thoughts, feelings, or gender of a human being whose brain did not fully virilize. Further, it is premature to conclude that the transgender condition has no organic component and is strictly a psychological defense mechanism.

    Prevailing wisdom used to be that the Sun revolved around the Earth, that the Earth was flat, that epilepsy was a sign of demon possession, and that alcoholism was a matter of self-control. Science has researched and proved all of these things to be false. Science has not yet conclusively researched the transgender condition.

    All of this begs for additional research into the transgender condition.

    Until the research becomes conclusive, I recommend that we allow for the possibility that being transgender is just another valid human condition.

    • Joseph Burgo says:

      I’m willing to be persuaded to that point of view because it seems entirely reasonable. But I think it implies that we ALL have to admit that we don’t know and stop acting as if we did by surgically altering people’s bodies and giving them artificial hormones. Wouldn’t you agree?

      • Rachel says:

        I would not agree. We provide surgery and medicine to people for many different conditions. I am not in favor of eliminating all treatment until we conclusive know the condition’s pathology, and how and why a treatment works.

        Alcoholic Anonymous is a great example of a success ahead of the science. Prior to Alcoholic Anonymous being formed, there was no science, therapy, spiritual, or self discipline approach that could provide consistent, reproducible treatment for an alcoholic. AA worked. Science had no idea why. The APA has spent decades studying how and why AA works. There is actually science that now understands why and how AA works. Further, the APA has over the past 10 or 15 years begun to apply the lessons learned from alcoholic families to other types of dysfunctional families. Should we have banished AA because there was no science to support it? No.

        In the 1500′s science proposed a hypothesis that something called a “germ” spread diseases. It was over 300 years before the germs theory became accepted science. Just because there was no science that supported the hypothesis that does not mean the hypothesis was wrong. Nor does it mean that an effective treatment based on that hypothesis should have been discarded due to the fact that no one had proven that a disease was caused by a “germ”.

        In the case of the transgender condition, there is science that supports this condition. We can debate the conclusiveness of the science, but there is actual science that suggests the transgender condition is a valid human condition. Further, the AMA and APA recommended treatment program works in fighting a condition that has an incredibly high mortality rate. If we have something that works, I would not want to throw it away just because it is not perfect or just because we don’t have all the answers.

        • Joseph Burgo says:

          I think that likening AA to surgery that forever changes one’s body is a stretch. If AA meetings don’t work out for an individual, there are no long-term consequences.

        • Karen says:

          “Prior to Alcoholic Anonymous being formed, there was no science, therapy, spiritual, or self discipline approach that could provide consistent, reproducible treatment for an alcoholic. AA worked. Science had no idea why. The APA has spent decades studying how and why AA works.”

          Perhaps you are unaware that not everyone agrees that AA works. In fact there is considerable disagreement about such a claim. I would encourage you to do more research before using AA as an example. I could cite a lot of examples which refute such a statement, but then it would not keep this on topic and that may be another article altogether.

          “There is actually science that now understands why and how AA works.”

          Can you cite your sources before making such a claim other than what AA provides? Again, there are people who refute such claims.

          “Further, the APA has over the past 10 or 15 years begun to apply the lessons learned from alcoholic families to other types of dysfunctional families.”

          Yes — the 12 step programs and actually there is disagreement about the benefit and success of these programs. I’m certain AA, like all other entities reliant upon people who join them or follow their path tend to cite or reference any study that is favorable towards their agenda.

          “Should we have banished AA because there was no science to support it? No.”

          Interesting choice of words. Suffice to say that perhaps AA needs to be investigated more closely, especially if there are other treatments that would deliver better results.

        • Karen says:

          On the subject of science and research there’s debate any way about bias which I strongly feel is merited.

          Researchers need to do better. Specifically they need to be much more careful about generalizing their findings across a very diverse group of people–like alcoholics or people that become estranged from their families of origin, etc., or that alcoholism is strictly and irrefutably a disease.

          With that said I sometimes feel research is undertaken to prove a researchers hypothesis rather than TEST it. In other words, the researcher is looking for confirmation of their BIAS. Suffice to say that this is particularly pernicious when it comes to research that generalizes findings across a diverse group of people.

      • Maddy says:

        Is it your opinion then, that people who opt for surgical procedures or HRT be denied them because the possibility they are mentally ill in some aspect exists?

        If so, do you hold the same position on facelifts and tummy tucks, as they also alter both the body, and how the body is perceived by self and others. In many cases it could be argued those undergoing age regression plastic surgery would be better served by accepting their bodies as they are, rather than how they would like them to be. Where do you believe the line should be drawn, who should be responsible for making the decision as to what body alterations are acceptable, and which ones indicate mental illness and thus require permission from a gatekeeper?

        -Maddy
        trans-atheist.net
        http://www.tinyurl.com/stitchertrans
        transatheistpod@outlook.com

        • Joseph Burgo says:

          Maddy,

          No, I don’t believe anyone should be denied elective surgery. It is their right to do as they like with their bodies. It is the lack of discussion of other causes of transgender identity that bothers me, and the political movement that has developed to support a view I disagree with.

          • Anonymous says:

            Hi Joe-
            This is Molly (hope you are well!)- I want to chime in here as a therapist and trans specialist. I think what you deduce here from this clinical experience is certainly true for some trans identifying folks. I disagree wholeheartedly that this is the case for all transgendered individuals. I work with transgender children with zero trauma histories who are firmly gender dysphoric and for whom hormone therapy and living in their felt gender has made them happy, healthy people. I also work with adults from happy supportive homes with no trauma who reeled in pain for years living in their biological gender, and whose pain has disappeared since transition- and not always with surgery. The reason I chimed in on this particular comment thread is that I want to assure you that within the competently and ethically practicing therapists specializing in gender, discourse about hormone or body altering treatments and who should undergo them is DEFINITELY happening. I would hope that in any specialty area, good and ethical therapists are treating underlying issues before jumping to the path of greatest resistance. The decision to move to HRT or surgery is taken very seriously and this line of treatment is not appropriate for everyone. Many people that I work with find that chemical /surgical intervention is not needed. Some people I have worked with have found that what they thought was gender identity issues was actual more deeply rooted identity issues. I find this is most common among teens. We identify this through thoughtful work therapeutic together. There are plenty of bad therapists working in this specialty, as there are in any, but I would encourage you to further explore how competent clinicians are working in this arena. I also really encourage you to further explore the research in this area as the article you sites earlier is certainly an outlying position among medical professionals who have been working and researching transgenderism for years. I would be happy to point you toward some of these resources!

            I think it important to consider the psychological cost of the stance you take if you are wrong. If being transgender for some people is a condition they are born with (I believe this to be true), then providing therapy with the core belief that their experience is coming from a deep and untapped childhood trauma could be extremely psychologically scarring- perhaps dissuading them or shaming them from moving forward with gender transition when this is what they truly need to feel at home with themselves. I would ask you to consider this point in the same frame as the pathology once assigned to homosexuality and the therapy done under similar assumptions.

            Finally, I will say that unlike what I have seen with body dismorphia, my clients who have gender disphoria feel immediate relief after transition. This feels very important in comparing these conditions- changing ones body with dismorphia simply increases the desire to further change, as you cited. For people who are transgender, a transition is finite- a ‘cure’ you might say. Should we look for other reasons for the disphora in their childhood or trauma history first? Yes. But I will tell you that the vast majority of the time in my clinical work, this does not end up fitting as a cause and pathology has been diminished or extinguished when helping people live in their felt gender.

            I hope these thoughts feel respectful and again, I would love to talk further or point you toward resources if you are interested!

            • Joseph Burgo says:

              Your in-depth experience speaks for itself. I would argue that the kind of shame I uncover in my work goes unaddressed in most other forms of treatment and doesn’t necessarily result from trauma. I’ve seen people from apparently “happy” families who were saddled with a great deal of unconscious shame.

              Still, your thoughtful comments based on great experience will speak to many readers. Thanks for taking the time to join in with your extensive experience.

            • Dolma Beck says:

              Molly, how could any one possible be so sure some people are transgender from birth? Or that a baby hasn’t been subjected to subtle/ not so subtle messages from care givers about their gender being wrong. Trauma, doesn’t have to be very visible, to others, to have occurred.. Non verbal messages from the mother of her disgust about her sons penis, she wanted a baby with a vagina/ her unconscious disturbances around her own sexuality.. Babies are very very sensitive to the clues offered by caregivers. No one, but the baby and his/ her mother( caregiver), were witnesses to all these , repeated, verbal/ nonverbal messages.

      • Jul says:

        So you suggest to do nothing until there is 100% scientific proof?
        What if someone is suicidal?
        And what if you apply this logic to global warming?

  15. Cameron says:

    Really wasn’t comfortable with this article, at all.

    “The experience of profound shame (resulting from an emotionally catastrophic infancy and early childhood) is equated in the person’s unconscious mind with her anatomical gender.”

    By what mechanism would this occur?

    ” This usually occurs at a very early age, often before language develops; it is for this reason that the transgender person will argue that she has “always felt that way.” For all intents and purposes, she has. On an unconscioius level, she early on came to believe that she was actually a boy trapped in a girl’s body; in later life,”

    How can you believe something before language develops? Thoughts are made of words.

    “she convinces herself that surgically altering her body is the solution to her psychological pain, her depressive feelings, her sense of being an outsider. Gender transition is the solution to shame, just as plastic surgery is the solution to shame for people like Toby.”

    And (assuming you are right) why do so many people feel ashamed about themselves and not claim to be transgender?

    It just seems SOOO judgemental to go from working with one person who was transgender and had shame issues to infer that all transgender people have shame issues or feel bad generally.

  16. SY_Kim says:

    I see that it can be a very controversial post due to the two facts. Now LGBT issues became an extremely sensitive issue, that mere questioning or exploring slightly over the boundary of a certain area that has strict orientation, you’re cornered as an ignorant homophobia. It is understandable because it is the starting stage of equality history. People are worried that just discussing the issue can hurt somebody, but I also think sometimes being overly-sensitive prevents us from truly understanding human diversity – although it is absolutely true that we should be careful about choosing words which is the reason my sentences are so long. And there also a stigma in our society about mental health that all the “labels” of mental traits are binary. It is either normal or abnormal, denying the fact that we all can be on a some point on spectra of mental disorders which makes a complex human-being.

    I was first a little bit offended when I first read your post, but as I read through people’s and your comments, I think I now get what you mean.

    I agree with your opinion on many points from my personal history. I’m biologically female, and I always thought myself as something different from girls, whether straight or lesbian, until I entered college. When I looked at a mirror and saw my body, I felt it as strange, although I didn’t feel uncomfortable with my body or want to change my sex. I even tried to check my genital with mirrors to assure whether I was an intersex(I know it sounds really funny). After getting into college, dating men and women, meeting a diverse kinds of people from LGBT scene, I became to accept more of my femininity and that I’m more of a fluid person in both gender identity and sexual orientation. So now I find it more comfortable to label myself as bisexual female or gender queer if I want to be precise.

    From my own case, I’m curious that if a social norm for gender becomes more fluid like these days does like you mentioned, or personal “perceived” strict gender norms become more flexible, then whether a person’s “gender dysphoria” can be eased.

    By the way, as I’m living in South Korea which is an #1 country obsessed with plastic surgery, I see a bunch of people who are quite satisfied with their initial big and common plastic surgery(double eyelid or nose) who don’t get another another one after that. Apart from the mechanism(possibly inner shame as you hypothesized) of transgenderism or Body Dysmorphism and if we only focus on people’s mental well-being or life satisfaction, what is your opinion about people who are just satisfied after “re-assignment” of their body? It’s true that there are people who became addicted to plastic surgeries or other ways or regret their sex reassignment surgery, it’s also true that substantial amount of people are just satisfied.

    • Joseph Burgo says:

      “From my own case, I’m curious that if a social norm for gender becomes more fluid like these days does like you mentioned, or personal “perceived” strict gender norms become more flexible, then whether a person’s “gender dysphoria” can be eased.”

      I certainly hope so! This seems a much more desirable alternative than surgery.

  17. Tamara says:

    There are several studies that have presented genetic and biological factors linked to transgenderism. For example, researches have found that the brains of transgendered male-to-female individuals resemble brains of cisgendered females, and vice versa with the brains of female-to-male and cisgendered males. Also, high doses of testosterone exposure in the womb may cause female-to-male transgenderism, as can certain chemicals and drugs. There are plenty of articles on PubMed about this.

    I am sorry and I hope you take this as constructive criticism, but you make yourself sound really ignorant when you present your own unfounded opinion like this, when evidence of the contrary is so readily accessible. Next time, please do research the topic more.

    • Joseph Burgo says:

      There’s lots of research on both sides of this issue. We all have a tendency to find studies that support our own views, and to lend far too much credence to the ones that do. Those studies you cite are hardly definitive.

      • Tamara says:

        Research on both sides is not the point. What is the quantity and quality of the research and its findings? Who conducted this research, how and why? One can argue that there are ambiguous findings in the research of any topic. The point that I think that you are missing is that you wrote this article without citing any other sources than your own theory. It makes this article seem “pop scientific”, or at best your own opinion on a topic you are not entirely familiar with. Using words like “politically correct” further lessens your chances of your stance being taken seriously, as other people have mentioned.

        You seem to insinuate that biological factors to transgenderism is my own view? This is not the case – before I researched this issue more closely I was also a skeptic, since I simply reproduced the notions of people around me instead of looking at the evidence for and against my preconceived ideas.

        • Joseph Burgo says:

          Would you be interested in having a respectful debate about the science involved here? You obviously know a great deal and if we were both to take a look at the same specific studies, discussing what they suggest and what they do or not prove, it would be useful for me and possibly instructive to other readers.

      • Karen says:

        I agree and essentially was trying to say the same thing on another reply.

  18. Gordon says:

    I think Joe is right. But this does not mean that I think transgenders need to be discriminated against or seen as insane. If this were the case I’d be shunned myself because I also have my struggles with shame, I just try to solve those issues in different ways (destructive to others if I’m not careful).
    Personally I have a small theory based on nothing scientific or even academic, but I think it might be interesting to share seeing where the subject is going (and also to figure out if I am going a little bit off the hook).
    I think all human sexuality arises mainly from psychological needs and these needs are the result of bad or not good-enough parenting. Sex is the delusion that we can fulfill all our psychological needs by entering the other person, as if we wanted to merge through every orifice. The other person is a substitute mother or father depending on which parent neglected you the most. If neither of them really neglected you in any significant way, then biology is the deciding factor. If both of them neglected you strongly and equally, then you become bisexual. Sex seems like the attempt to put a parent inside of you so he or she can then always be there to fulfill your needs. I think transgenders attempt to change themselves due to the delusion that if one is the other gender, they will be able to cope by themselves without having to rely on these substitute parents.
    But maybe it’s just that sex feels good and that’s why we do it. Maybe it’s a mix.
    Just in case anyone is wondering, I’m male and heterosexual.
    PS: Political correctness is an euphemism for the use of euphemisms and the avoidance of dysphemisms. I hate euphemisms.

    • Joseph Burgo says:

      Fascinating, Gordon! But I’m not sure what you mean by the P.S.

      • Gordon says:

        Well, to me the use of political correctness always seems like an effort to please the majority or the ones who have the power to change the majority. I see political correctness as a euphemism for being spineless and manipulative. Like let’s sugar coat all our opinions in an effort to dissipate the hate from those who disagree and to lure those who lack enough critical thinking. This sugar coating is full of euphemisms. The only good thing about political correctness is that it avoids dysphemisms (even though overused euphemisms sometimes become dysphemisms).
        It’s interesting to see how the use of political correctness changes the meaning of words. Person of color used to be a politically correct term, until people figured out that many people used that term because they wanted to please them instead of being genuinely not racist.
        It can also be condescending. Telling us someone “passed away” as if we aren’t mature enough to handle the fact that someone died.

  19. Evan says:

    Transgender is interesting. It would be nice to have a culture where people are accepted for who they are – so we could sort out if neuroses are due to having to cope with social judgements.

    I’ve been reading a book about someone who transitioned from female to male. He felt trapped in a woman’s body since he could remember. He liked to do things that boys dead and didn’t have any interest in girl things. The question that was never addressed (the silence screamed to me) is: What if someone had come a long and said, “Lots of girls do what you want to do! People who say otherwise are just silly. Here’s a book about the Amazons, here’s another about Kali.”

    To me those who believe they were born in the wrong bodies don’t seem any less sane than those who believe they were born in the right ones.

    • Reggie M says:

      You have hit the nail on the head. If we stopped worrying so much about which things are “girl things” and which things are “boy things” and just let everybody play with the toys they like, wear the clothes they like, walk and speak in whatever way they are comfortable, etc. we’d all be better off. We could stop defining who is a boy or girl according to who is playing with trucks and who with dolls. A girl who likes to play with trucks could just be a kid who likes to play with trucks, instead of a boy, and a boy who likes to play with dolls could just be a kid who likes to play with dolls, instead of a girl. In a such a world, I have to wonder if transgenderism would even exist.

  20. Rachel says:

    Jo
    Have you come across the controversy re transphobia within DGR?

    http://www.deepgreenresistance.org/en/radfemfaqs

    Very hotly debated lately.

    Rachel

  21. Miranda L. Payne says:

    Dear Joe. I always find your posts interesting even when I have found them sometimes irritating ( which probably means I disagreed with them or perhaps they were too close to the bone!), but I found myself in absolute agreement over this one, although I have some sympathy with the defences and sensitivities of those suffering from Body Dysmorphic Disorder and gender issues. My experience comes from my own BDD when I was young and my daughter’s when she was a teenager. I wanted to get my first job in order to pay for cosmetic surgery and so did my daughter later. Luckily, we both grew out of it when we got older, made accepting friends and developed self acceptance. I was always really glad that that happened before I went down that path. So what you say about lack of self acceptance being the drive resonates with me. It is interesting that my daughter developed it as well, despite the fact that I always felt pleased with her appearance. But, obviously generations of feeling inferior seeped through! Hers started when she felt rejected by her peers at age 12 and she developed the belief it was because she did not look acceptable and so all her energy went into ‘fixing’ the way she looked instead of being able to see that it was not her appearance, but self esteem that was the problem. I also have a close friend who is female and who was a very pretty girl who has always wanted to be a man and now is. That is her decision and i hope it makes her happy. But I was always struck by the fact that she reminded me of my daughter in many ways and I always felt a little sad for her that she did not accept herself as she was. She said she always wanted to be like her father -strong- while she saw her mother as weak and passive and her father was always criticizing women for being inferior so it is not hard to see why she identified with him! She herself, while she identifies with men and wants to have a ‘wife’ , often ridicules the “little women” that she purports to be attracted to! And I experience that firsthand from her! So much for my feminist ideals! Anyway this has become longer than I meant it to be. I just wanted to say I am with you on this one and I have also experienced being misjudged for challenging sacred cows or naming the elephant in the room and I assume we all know that what you are giving is your opinion even if we don’t agree with it. And I know I cannot presume to know what motivates every person who wishes to change their gender identity. It occurs to me that some fear a return to the bad old days of discrimination and are therefore touchy and sometimes this makes it hard to have an open discussion.

    • Joseph Burgo says:

      Thank you so very much for this. Your experience has a kind of authority that mine does not and I appreciate hearing from someone able to confirm some of my views. I agree that many people fear a return to the “bad old days of discrimination,” but that isn’t a reason not to talk about these issues.

      • Miranda L. Payne says:

        Thank you for your thank you! I can speak with firsthand authority on many mental health issues, having suffered from so many of them, along with mt friends, myself! Seriously, thanks for the acknowledgement and glad it helped!

  22. Y says:

    I’ve read your post several times now, and while your final statement about Gender Identity Disorder being a severe form of Body Dysmorphic Disorder is indeed controversial, it is YOUR opinion, and should be respected as such. Others, of course, are free to disagree, but they should do so respectfully.

    I know very little about the subject, but I definitely agree that anyone gearing up for a major life change, such as gender reassignment surgery, should consult with a psychotherapist first. It just seems like the smart thing to do.

    I once posted a Richard Dawkins quote on Facebook, and some of my family members bullied me so badly that I deleted my page, and haven’t been back since. It was a really traumatic experience, and ironically, the Dawkins quote was about looking for evidence of love, instead of believing empty words; My family proved that they only love the version of me that doesn’t challenge their beliefs.

    Press on, Dr. Burgo. You’ll attract more followers in the end if your writing inspires debate, and remains honest, instead of politically correct.

  23. Cat says:

    Thanks Joe for your post. As always thoughtprovoking.

    It was quite shocking to read some of your views and disappointing for many of the reasons outlined above. Thanks Rachel, (and others) for your eloquent counter arguments. I agree that surgically reconstructing your body may be a misguided attempt to attain equilibrium. But so what? This is their lived reality. We as a community need to accept people for who they are or who they say they want to be known because it respects them as an autonomous person and their own meaning of what we think we all know to be real. Of course we should also at the same time adhere to the harm principle and try to minimise any unnecessary or physical harm. Our relationship with our gender and the society we live in is problematic from birth, with all its restrictions, expectations and failures.

    Political correctness is basically good manners. It means Hearing other people’s stories and REAL lived experiences and extending them the courtesy of acknowledgment, if not full acceptance. It is not shouting down the other’s arguments by attacking the person. It champions the pluralism of ideas and difference in a respectful and accommodating manner. None of us see the world in the same way.

    Illuminating post!

    • keg says:

      “Political correctness is basically good manners”

      ————————————-

      Really? You must live on a different planet because the most intolerant, judgmental, spiteful and malicious people I have ever met ascribe to and embrace political correctness where all views are welcome unless it disagrees with the politically correct agenda. Note the many universities where pro life clubs are banned. Why is that? Huh? I also note that when Anne Coulter travelled to Canada a few years ago to give a speech at University of Ottawa (university of zero) she was shouted down by leftist politically correct students who had been taught what to think, not how to think, another graphic demonstration of intolerance and hatred.

  24. Catherine says:

    It is scientific though, that 1 in every 100 births has some sort of intersex component, and often times intersex children do not have a choice in gender identity. There is more than just “belief”, and your column here seems to be a bit insensitive in that you don’t really seem to have all the facts.

    I encourage you to learn more.

    http://www.isna.org/faq/frequency

    • Joseph Burgo says:

      This is important information, but what it says to me is that something has gone wrong, nature has somehow screwed up, and the result would be core shame (the felt awareness that your development has gone awry from Winnicott’s inbuilt “blueprint for morality.” I take up this issue in more detail in my most recent post.

  25. Catherine says:

    Also, the reason GID is in the DSM is that it’s presence helps transgendered people attain services in the medical model of psychiatry. A diagnosis of GID can help with transition activities that involve the medical community (i.e. the “treatment” for GID may be surgery or hormone therapy).

    • Joseph Burgo says:

      It’s a paradox, as Andrew Solomon has pointed out. Transgendered people don’t want to be viewed as having an illness but at the same time, they need a diagnosis of GID to get coverage.

  26. Katie says:

    I am a twenty-five year old female. Growing up, I loved being female. I liked my vulva, my vagina, my long blonde hair. I liked my strength, my fun-loving attitude, and my wit.

    When I “grew up” and was raped in a park at age twelve…. and when I was told my society that strength was male, being fun-loving instead of uptight was male… that my wit, my hilarious, unexpected, telepathical wit – were all masculine traits…it was then that I wanted to be male.

    It was the breaking point. When I was told the good things about me were actually masculine traits in a female body. That I was a female body only. A vagina, hair, a dress. Anything good must have been borrowed from men.

    My raucous laugh can’t be mine.

    I no longer wanted to be female. I cropped my hair. I wore a masculine uniform.
    I want to be the narcissistic hero that society worships but instead I am gamine failure. I am a shadow of and slave to the men in my life.
    Neither here nor there on the gender binary because it is too dangerous for me to be anywhere. I exist in a dark corner crying never to be seen or validated.

  27. Francesca says:

    I would like to add my take on this. I would start my saying that I’m very pro-trans gendered people, but very against mindless PCism.

    Instead of thinking about it in terms of shame, I would try and bring a different way of thinking to it, not sure if this is the right vocabulary, but I hope you can maybe get the gist nonetheless,. As I see it, everyone is born into a specific family and society, where certain things are considered possible and real, and other things are considered impossible and not real. There is space for a certain ways of being, and no space for other ways of being. There are pressures in various directions for all people.
    I don’t doubt the people who wind up trans are born into a specific set of pressures and realities, but this is the case for absolutely everyone, I don’t image is anyone out there whose personality is not shaped by some combination of possibilities and impossibilities, this is what makes everyone unique and who they are. High powered business men haver certain limits, housewives have certain limits, etc.
    Some identities get questioned and others don’t though. To me, this is about prejudice only, the idea that certain ways of being are more ‘desirable’ than others .
    As an example, I was born into a family where i wasn’t really supposed to have an identity as a person in a social sense, you could say I was shamed I guess. But then as an artist, a creative person, I have an extremely rich life; people who don’t do creative work think this is an impoverished way of being but its really not, it;s only different.
    I see being transgendered as a very normal and creative response to whatever family and social circumstances the person is born into, just like anyone else. In terms of people who are genderqueer, i.e. who mix and match gender and stay in the middle ground, I think it’s a more rich life in many ways to experience oneself as having both traditionally masculine and feminine qualities, and to be out about it. Not to mention it’s probably a lot more honest and realistic a way of being in the world than a lot of the grotesque barbie-girls and ken-dolls you find in the mainstream.
    No one questions people who want to emigrate from one country to another, or change professions, etc. Gender goes deeper than that of course, but at the end of the day, if people are complaining about it, it’s because it makes them uncomfortable.

    And yes, in light of prior posts around the need to compassionate to narcissists….I would question the emotions behind this post.

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