The regimen of surgical mutilation that until the day before yesterday went by the name “sex-change operation” — the catechists now instruct us to call it “gender-confirmation surgery” — has undergone a remarkable evolution: from banned to fringe to tolerated to celebrated to federally subsidized under Medicare to obligatory in Andrew Cuomo’s New York, with the governor announcing that insurance companies operating under his thumb will be obliged to pay for procedures relating to what the American Psychiatric Association calls “gender dysphoria.” For example, in the case of a woman who wishes to live as if she were a man, insurance companies may not decline to pay for procedures such as elective mastectomy — which is to say, for the surgical removal of perfectly healthy organs — on the grounds that such procedures are cosmetic, which of course is, categorically, precisely what they are. That Governor Cuomo believes himself entitled to impose this by fiat has gone unremarked-upon in New York, the servile population of which has accustomed itself to strongman rule in both the capital and the principal city.
As a great man* once said, the arc of the moral universe is long but it bends toward mandatory insurance coverage for elective genital amputation.
The American Psychiatric Association has a funny relationship with “gender dysphoria.” It was, until the most recent revision of the APA’s Diagnostic and Statistic Manual of Mental Disorders, known as “gender-identity disorder,” and the word “disorder” is a two-edged sword: In some cases, people so diagnosed have had the diagnosis used against them, for example in custody disputes; at the same time, activists quietly welcome its continued classification as a “disorder,” because, as Governor Cuomo reminds us, cosmetic procedures attached to a medical diagnosis need no longer be considered cosmetic procedures, and so insurance companies can be brought under political discipline. Similarly, the diagnosis gives weight to nondiscrimination rules and the like. As Dana Beyer, a transgender advocate and failed Democratic political candidate in Maryland (“Gay incumbent fends off transgender challenger,” the headline read), “A right-winger can’t go out and say all trans people are mentally ill. . . . It no longer matters what your body looks like, what you want to do to it — all that is irrelevant as far as the APA goes.”
As goes the APA . . .
The DSM characterizes gender dysphoria as “a marked incongruence between one’s experienced/expressed gender and assigned gender.” That “assigned” is a textbook example of begging the question, but the defining characteristic of gender dysphoria — and the defining characteristic of the public discussion of it — is the conflation of the objective and the subjective. “Dysphoria” itself is a neologism that simply means a bad feeling, and such is the power of contemporary sentimentalism that a feeling intensely bad enough is taken to reorganize reality: A cosmetic mastectomy is not a cosmetic mastectomy if one wants rid of one’s breasts badly enough. What was cosmetic is therapeutic, what was female is male. Presto-change-o.
Of course, reality is not reorganized — not officially — until the New York Times says it is, and the newspaper has enthusiastically adopted the Orwellian abuse of the English language necessitated by participating in this modish joint delusion.
Lee Albertorio felt like a man trapped in a woman’s body. After serving in the Air Force, he began taking hormones, which deepened his voice and made his physique more masculine.
He changed his passport to reflect that he was male, and last year he decided to have a mastectomy, known as top surgery. But his insurance company told him the operation was cosmetic and refused to cover it.
This being the New York Times, there is no indication that the subject is a biologically female human being — a woman — who is undergoing a series of procedures that will help enable her to cultivate for herself and for the general public the illusion that she is a biologically male human being — a man. The Times is hardly alone in this: The Daily Mail, reporting on a couple’s decision to “correct” the birth announcement of their daughter (“He informs us that we were mistaken . . . We would now like to present our wonderful son”) plays the same game, describing the two as “the parents of a 19-year-old man.”
It is fitting that this intellectual regression into primitive magical thinking — remove the breasts, say the necessary words, and a woman is confirmed as a man — has been accompanied by a parallel regression in the use of the English language — women are “he,” men are “she,” cosmetic is “therapeutic” — and that all this regress goes under the name of “progress.”
This will end badly. Activists have suggested, energetically, that I should be imprisoned on hate-crimes charges for refusing to follow the pronoun etiquette they demand when it comes to trans people. That is the nature of such sexual theater in the 21st century: What was permissible in Mario Cuomo’s New York is obligatory in Andrew Cuomo’s.
*Well, one never knows, now does one?
— Kevin D. Williamson is roving correspondent at National Review.