The psychiatrist Christian Spaemann, son of the great Catholic philosopher Robert Spaemann, has written a remarkably intelligent and balanced article on “transsexuals” and how the Church ought to give them pastoral care. The article was so good that I agreed to help translate it for First Things.
As a psychiatrist Spaeman has a lot to say about the psychological suffering of those who consider themselves transsexuals, and about the appalling way in which that suffering is being instrumentalized today, and the appalling haste with which young persons are being lead into drastic measures:
Transsexuality is a cause of great suffering, above all for the people in question, but also for their family members and especially for their children. Hormonal or surgical means can sometimes lessen this suffering, but they cannot entirely remove it. […] The phenomenon of transsexuality has been instrumentalized by gender activists for the sake of promoting their socio-political goal of relativizing the dichotomy of the sexes. (This instrumentalization is fundamentally absurd, since transsexuals, with their strong desire to belong to the other sex, precisely confirm the dichotomy of the sexes). […] The haste with which even young people at the age of puberty are led to surgical measures is worrisome. It is no credit to the current state of medical and psychological science that it has no way to grapple with a deep-seated disruption of identity, other than with hormones and knives. The drastic surgeries and the lifelong doses of hormones can accomplish nothing more than a kind of artificial sex. A transsexual man will always be a woman who has been surgically made into a man; a transsexual woman will always be a man who has been surgically made into a woman.
The part of his article that gave me the longest pause was that the there can be circumstances in which so-called “sex-change surgery” might be permissible:
The suffering of those who feel themselves to be transsexual can be so great—to the point of making them suicidal—that from the perspective of the Church one can hardly categorically forbid surgical and hormonal measures to reduce their suffering, as a last resort after attempting other measures. The proscription of self-mutilation must here be weighed against the good of reducing suffering.
His point seems to be that in some cases such operations are analogous to an amputation: given a certain psychological state they might be necessary to save a life. Perhaps he is right. (In any case, it is important to understand such operations correctly: as he argued above, they do not actually alter a person’s sex).
Interestingly Spaemann’s piece in many ways parallels a recent piece by a “Catholic transsexual” named Aoífe Hart. The two pieces are of course quite different in tone and emphasis, but Hart does make some of the same points as Spaemann. Like Spaemann, Hart rejects gender theory and argues that transsexuality confirms the dichotomy of the sexes. And Hart’s argument for the permissibility (in some cases) of an operation is also quite close to Spaemann’s:
Transsexuality and “gender theory” are different. Very different. To explicate that would be a subject for another long post. But transsexuality can be understood — indeed, must be understood — as a distinct medical construction with clinically observed treatment protocols (ones that are beneficial, but not perfect) enacted to bring relief to the extreme psychiatric distress of sex dysmorphia, a clinical condition with specific symptoms.
I’m still unsure about the permissibility of the particular “treatment protocols” meant here, but Spaemann and Hart have certainly made me think more deeply about the question.