Philosophical Puzzles about Transgenderism
The most remarkable feature of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is that its description of gender dysphoria strongly implies that the human mind can exist in the wrong body. Because of this, the DSM-5 does not recommend a psychiatric cure for this condition. Instead, it recommends that the body be altered to conform to the patient’s (apparently correct) mental perception. (Such distress may, however, be mitigated by supportive environments and knowledge that biomedical treatments exist to reduce incongruence.” Supportive environments refers to settings that affirm that the person is indeed a member of the opposite sex. Biomedical treatments refers to cross-sex hormones and sex reassignment surgery). In earlier editions, psychiatric measures were considered the norm for treating gender dysphoria (listed under another name), but the DSM-5 now says that the distress experienced by these patients does not result from any underlying illness.
The psychological distress is caused, instead, by the extraordinary fact that the mind finds itself in the wrong body. A secondary cause of distress, the manual adds, is society’s reaction to the patient’s correct estimation that he or she is indeed in the wrong body. The denial that a person is wrongly sexed causes the patient further harm.
Consider the case of a husband who tells his spouse and children that he is in the wrong body and so plans to transition to the opposite sex. He will soon become a woman. He tells the family that he expects them to address him as such. This announcement, not surprisingly, generates great shock and dismay. The wife understands that this is the end of their wedding vows. The children understand that this is the end of their relationship with their father.
The DSM-5 asks us to believe not only that the decision of the father in this case is correct but that the family is partly at fault for exacerbating his condition. From a human standpoint, the reactions of the spouse and children would seem to be completely natural, but according to the manual, they are contributors to psychological harm. The correct response would be for them to accept that the mind of their father, indeed, should be in the body of a woman.
The medical literature offers no evidence that it is possible for a mind to be in the wrong body. The description of gender dysphoria given in the DSM-5 rests not on empirical data but on philosophical premises. These premises appear to be incoherent and dangerous.
What Evidence Counts?
If it is possible for the mind to be in the wrong body, facts must be presented. The purpose of the DSM-5 is not to provide the scientific data that verify the accuracy of any of the various psychiatric conditions it lists but to help practitioners identify the signs of illness so that they can give their patients appropriate treatment. We need to go elsewhere if we are to find confirmation of the view that the mind can be in the wrong body. Hopefully, the American Psychiatric Association does not think that a person’s mere say-so makes this true. The anorexic believes that she is fat, but that is obviously false. Liposuction would not be a recommended treatment.
Beyond the mere fact that some say they are members of the opposite sex, there must be some evidence that shows that the mind can indeed be in the wrong body. Some hypothesis would need to be proposed, tested, and proved by empirical means. Not only is there is no such proof in the literature, but it is difficult to imagine what kind of evidence would be confirmatory. What we find instead are studies on whether those who have undergone sex transitioning have improved psychological health. There are few of these, and they do not show clear benefits.
One example of a testable research question is, Do the brains of men who feel that they are women show distinctive female characteristics? (The text vaguely suggests that gender dysphoria is “a form of inter-sexuality limited to the central nervous system.) Are there physiological aspects of certain brains that indicate that a female mind might exist in a male body? Scientists, by carrying out brain scans, might be able to identify those features and so supply evidence that this person’s mind is indeed in a body that is wrongly sexed. When did the dysphoria originate? If the mind is currently in the wrong body, was this true from birth, or was it true even earlier in fetal or embryological development, or does it occur at puberty when sexual changes begin to exert themselves?
The oddity of looking at this problem from a temporal perspective is that the mind must be in the wrong body before it realizes the fact. Otherwise, it would be nothing more than a mental projection. But this is not permissible according to the DSM-5. Gender dysphoria is not a mental illness. The suggestion that it is only causes the sufferer further distress. Yet given the priority of bodily development over mental development, we would expect the mind to conform to bodily reality. This expectation is hard to avoid, because the mind sees itself as an embodied being over the course of a lifetime. In the case of gender dysphoria, however, the mind comes to see the body as the wrong sex. The problem, therefore, exists within the mind–body relationship. Yet this simple observation once again leads to the conclusion that the mind’s perception is the problem. The body is not aware of the mind. The mind is aware of the body. The fault, therefore, would seem to be an error in judgment. Yet the DSM-5 rejects any conclusion of mental error. According to its authors, the body is at fault and needs to be changed.
Some Recent Studies
Some preliminary studies of this sort have been done. One used brain scans to search for differences between those with gender dysphoria and a control group not so afflicted. The authors state, “Our findings suggest that the neuroanatomical signature of transgenderism is related to brain areas processing the perception of self and body ownership.” If true, this would support the view that gender dysphoria is a false perception that is reflected in an unusual structuring within the brain. As with all such studies, the question of cause and effect is critical. Does incorrect thinking about one’s gender cause the brain to develop this variant structure or is that structure the cause of the incorrect thinking? Either way, this is not empirical evidence that the brain is in the wrong body. It is evidence that the mind perceives the body incorrectly.
A review study from 2020 surveyed available research on the broader topic of the brain and sexual differentiation. It reports that “the evidence suggests that the sexual dimorphic brain could be the anatomical substrate of psychosexual development, on which gonadal hormones may have a shaping role during prenatal and pubertal periods.”5 The broad character of this conclusion shows how preliminary such studies are, yet it supports the view that the body takes precedence in sexual development and should normally produce mental perceptions that correspond to given sexual form.
Materialism and the Brain
Catholic philosophy sees the spiritual soul as the source of life, motion, and intelligence within the body, but science and psychiatric practice are dominated today by the philosophy of materialism. Medicine reduces thought and mental functioning to the processes of the physical brain. If the mind is reducible to the electrochemical activity of the brain, as the materialists say, then those who suffer from gender dysphoria have wrongly sexed brains. One part of the body, namely, the brain, is at odds with the rest of the body, which is in opposition to itself as a whole.
But this is also an unacceptable view according to the DSM-5.
The brain cannot be wrongly sexed, because the mind of one who suffers gender dysphoria is healthy. The person experiences discomfort not because the brain is wrongly sexed but because he or she is physically in the wrong body. The earlier suggestion, therefore, that one might look for feminine traits within a male brain or masculine traits within a female brain now turns out to be a false approach. According to the materialist premise, if the mind is healthy, then the brain must also be healthy because the mind is reducible to the brain.
We must look instead to the rest of the body to discover how it happens to be wrongly sexed. What errors or deformities can be empirically identified in the body of a person suffering gender dysphoria? The authors of the DSM-5 suggest that these problematic elements are the male characteristics of a man who thinks he is a woman or the female characteristics of a woman who thinks she is a man. Yet it is obvious that there is nothing defective about the sex characteristics of their male and female bodies. They are healthy and functioning correctly.
We, thus, reach another impasse. We are searching for evidence that those who suffer from gender dysphoria experience mental distress because their bodies do not have the appropriate sexual characteristics. There is no evidence in the literature that explains how such a gross error in physiological development could have happened or when it might have occurred. The difficulty lies not only in the lack of evidence but in the appearant incoherence of the very claim that this is possible. Every effort to make sense of the description given in the DSM-5 brings us back to the conclusion that it is not the body that is at fault, but rather the mind.
We are led to conclude, therefore, that the treatment suggested for gender dysphoria in the DSM-5 is erroneous and dangerous. Not only is there no evidence that it is possible for a mind to be in the wrong body, but the effort to describe what kind of evidence might be produced in favor of this thesis leads to contradictory conclusions. Judged by the materialists’ own standards, the effort fails. Unless some coherent explanation can be given for the extraordinary claim that it is possible for the mind of a person to develop within a body of the wrong sex, we are obliged to reject the treatment advice given for gender dysphoria in the DSM-5. The advice is incoherent, false, and damaging to families.
Edward J. Furton, MA, PhD, is the director of publications at The National Catholic Bioethics Center.
