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    Psychiatrist: Transgender Surgery Isn’t the Solution

    Updated: August 2, 2017 at 12:44 pm EST  See Comments

    Editors’ note: This op-ed was originally published at The Wall Street Journal and is authored by Paul McHugh.

    The government and media alliance advancing the transgender cause has gone into overdrive in recent weeks. On May 30, a U.S. Department of Health and Human Services review board ruled that Medicare can pay for the “reassignment” surgery sought by the transgendered—those who say that they don’t identify with their biological sex. Earlier last month Defense Secretary Chuck Hagel said that he was “open” to lifting a ban on transgender individuals serving in the military. Time magazine, seeing the trend, ran a cover story for its June 9 issue called “The Transgender Tipping Point: America’s next civil rights frontier.”

    Yet policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention. This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.

    The transgendered suffer a disorder of “assumption” like those in other disorders familiar to psychiatrists. With the transgendered, the disordered assumption is that the individual differs from what seems given in nature—namely one’s maleness or femaleness. Other kinds of disordered assumptions are held by those who suffer from anorexia and bulimia nervosa, where the assumption that departs from physical reality is the belief by the dangerously thin that they are overweight.

    With body dysmorphic disorder, an often socially crippling condition, the individual is consumed by the assumption “I’m ugly.” These disorders occur in subjects who have come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way that they appear to others. Such ideas work like ruling passions in their subjects’ minds and tend to be accompanied by a solipsistic argument.

    For the transgendered, this argument holds that one’s feeling of “gender” is a conscious, subjective sense that, being in one’s mind, cannot be questioned by others. The individual often seeks not just society’s tolerance of this “personal truth” but affirmation of it. Here rests the support for “transgender equality,” the demands for government payment for medical and surgical treatments, and for access to all sex-based public roles and privileges.

    The remainder of this article is available in its entirety at Wall Street Journal

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