On July 24, 2013, the U.S. Department of Justice announced that it had reached an agreement with the public-school district of Arcadia, Calif., for the resolution of certain “sex discrimination” claims. The case involves a girl who desires to use boys’ facilities, such as restrooms and locker rooms, to be housed with the boys in “sex-specific overnight accommodations at a school-sponsored trip,” etc. In doing so, the DOJ cites Title IX of the Education Amendments of 1972 and Title IV of the Civil Rights Act of 1964, which, in the department’s words, “prohibit discrimination against students based on sex.” But the girl is not being discriminated against because of her sex. Even the DOJ implicitly concedes as much. Rather, the problem is her “gender identity,” which is, the DOJ reports, male. Having invoked those magic words, the DOJ is empowered to commit violence upon language and reason both, describing its investigation into “allegations of discrimination against a transgender student based on the student’s sex,” that being the sex of a student “whose gender identity is male and who has consistently and uniformly presented as a boy at school and in all other aspects of his life for several years,” and who henceforth “will be treated like other male students.”
The DOJ has placed its imprimatur upon a fantasy involving a legendary creature: the person of one sex trapped in the body of a person of another sex.
It is not an entirely new legend, nor one without some basis in reality. The Roman emperor Elagabalus is (according to the seriously dubious historical resources available to us) said to have offered half the empire to any physician who could effect a sex change upon his person (“by means of an anterior incision,” in the wincingly clinical phrase of Cassius Dio), but, having failed that, had to content himself with cross-dressing and referring to himself in the feminine. Times being what they were, the Romans could put up with a great deal of depravity from their emperors, but were said to have been particularly piqued by Elagabalus’s insistence that he was the empress of Rome intending to make his husband (a favorite slave) the emperor. The emperor Nero had ordered the sex change of a male slave who resembled a woman he favored, according to an almost certainly fictitious account. The myth of Tiresias we all know, as well as the many classical characters, such as Attis, and Jupiter, who assumed female form when seducing Callisto. (The offspring of that union produced Arcas, namesake of Arcadia, both the one in Greece and the one in California.) There are tales of sex change in the Mahabharata. And we have the real-world experiences of those such as François Timoléon, abbé de Choisy, the notorious French cross-dresser, who wrote in his memoirs: “I thought myself really and truly a woman. I have tried to find out how such a strange pleasure came to me, and I take it to be in this way. It is an attribute of God to be loved and adored, and man — so far as his weak nature will permit — has the same ambition, and it is beauty which creates love, and beauty is generally woman’s portion. . . . I have heard someone near me whisper, ‘There is a pretty woman,’ I have felt a pleasure so great that it is beyond all comparison. Ambition, riches, even love cannot equal it.”
The abbé de Choisy is the sort of man that Dr. Paul R. McHugh had in mind when he wrote: “When you discuss what the patient means by ‘feeling like a woman,’ you often get a sex stereotype in return — something that woman physicians note immediately is a male caricature of women’s attitudes and interests. One of our patients, for example, said that, as a woman, he would be more ‘invested with being than with doing.’ It is not obvious how this patient’s feeling that he is a woman trapped in a man’s body differs from the feeling of a patient with anorexia nervosa that she is obese despite her emaciated, cachectic state. We don’t do liposuction on anorexics. Why amputate the genitals of these poor men? Surely, the fault is in the mind, not the member.”
Dr. McHugh became a controversial figure in the 1970s when he was the chairman of the psychiatry department at Johns Hopkins University and set about dismantling its “Gender Identity Clinic,” which was established in 1965 and performed what we all have agreed to call “sex-reassignment surgery,” a term that begs the question. Sex is a biological feature that is present at the level of DNA. That fact is known even to Barack Obama’s Justice Department, which in April disclosed through an anonymous leak (of course) that it had discovered “female DNA” at the site of the Boston-marathon bombing. The ladies and gentlemen at Eric Holder’s disposal did not ask the DNA whether it identified as male or female, but instead took a look at the chromosomes, which answered the question for them. A sample taken from any man or woman could be used in precisely the same way, regardless of how that person self-identifies. Feminists have long argued that biological sex and social gender should be considered disconnected, but as a matter of law (and more than law) we are expected to treat them as a unified phenomenon: Eric Holder’s DOJ argues that the case in Arcadia is one of sex discrimination, even though there is no serious question as to the sex of the girl in question. By this standard, not only is it sex discrimination to treat a girl as a girl when she desires to be treated as a boy, it is sex discrimination to maintain such categories to begin with.
We have created a rhetoric of “gender identity” that is disconnected from biological sexual fact, and we have done so largely in the service of enabling the sexual mutilation of physically healthy men and women (significantly more men) by medical authorities who should be barred by professional convention if not by conscience from the removal of healthy organs (and limbs, more on that later), an act that by any reasonable standard ought to be considered mutilation rather than therapy. This is not to discount the feelings of people who suffer from gender-identity disorders — to the contrary, those feelings must be taken into account in determining courses of treatment for people who have severe personality disorders. But those subjective experiences do not render inconsequential the biological facts: A man who believes he is a woman trapped in a man’s body, no matter the intensity of his feeling, is no such thing. The duty of the medical profession is not to encourage and enable delusions, but to help those who suffer from them to cope with them. It is worth noting here that as a matter of law and a matter of social expectation, the fiction of sex change is treated as the paramount good: We are not expected to treat those who have undergone the procedure as men who have taken surgical and hormonal steps to impersonate women (or vice versa) but as people who have literally changed sex, which they have not — no more than Dennis Avner, the famous “Stalking Cat” who attempted to physically transform himself into a tiger, changed species.
Unhappily, we are poised to move in the opposite direction. Medicare currently does not cover sex-reassignment surgery, but it is considering changing that policy. In March, the Department of Health and Human Services solicited public comment on the possibility of reversing the government’s policy of not paying for sex-reassignment surgery. It quickly withdrew that proposal after media reports, but is reviewing an administrative challenge to its characterization of sex-reassignment surgery as “experimental” and therefore ineligible for Medicare coverage.
Even if we were to believe that a course of medical mutilation could make someone happier, this therapy seems often not to be therapeutic. A large number of those who undergo sex reassignment, as many as one in four by some estimates, pronounce themselves unhappy with the procedure. Dr. McHugh in a 1992 essay wrote about its long-term consequences: “Age accentuates the sad caricature of the sexually reassigned and saps their bravado. Some, pathetically, ask about re-reassignment.” Dr. James Bellringer, a British physician who has performed hundreds of sex-reassignment surgeries at the Charing Cross Hospital gender-identity clinic, points out in defense of the practice that about one-fifth of those who are denied the procedure attempt suicide; but a study conducted by the British National Health Service found practically identical — 18 percent — suicide-attempt rates for those who had undergone the procedure. (Mr. Avner, whose feline transformation also took a toll on his personal life — “Being a tiger is more important to me than humanity, which is difficult for many women to cope with” — was found dead of an apparent suicide.) The Aggressive Research Intelligence Facility, which advises the NHS on the effectiveness of treatments, conducted a broad review of the research literature and “found no robust scientific evidence that gender reassignment surgery is clinically effective,” according to the Guardian, the liberal newspaper that commissioned the review. A study by the scholarly journal BJUI (formerly the British Journal of Urology) found that some 24 percent of those who undergo reassignment reported that they were unhappy with the cosmetic results, and 20 percent reported that they were in general dissatisfied with the procedure. Those numbers would be high for nose jobs or breast implants; they are sobering for a course of therapy that involves elective amputations.
On that subject, elective amputations of healthy arms and legs are quietly offered as “treatment” for something we are expected to call Body Identity Integrity Disorder, which is “characterized by a burning and incessant desire to amputate an otherwise perfectly healthy limb,” in the words of Mo Costandi, a neurobiologist who writes a science column for the Guardian and advocates the procedure. The stories of these amputees trapped in amputationless bodies will sound familiar. “To date, there have been approximately 300 documented cases of BIID,” Mr. Costandi writes. “Most of these are male, almost all of whom desire amputation of a limb on the left side of the body. More often, it is the arm that is affected rather than the leg. All of these so-called ‘wannabe amputees’ know exactly where they want the limb to be cut off, to the millimetre, and almost all of them remember seeing an amputee at a very young age and thinking that they should have been born like that themselves. ‘When I was 3 years old, I met a young man who was completely missing all four of his fingers on his right hand,’ said one 21-year-old female BIID sufferer, ‘and ever since that time I have been fascinated by all amputees, especially women amputees who were missing parts of their arms and wore hook prostheses.’” Another patient says, “My left foot is not part of me.” (But it is.) There is a sexual component in many (but not all) of these voluntary amputations, a fetish documented as far back as in Richard von Krafft-Ebing’s Psychopathia Sexualis (1906).
As with the invention of “personhood” in the abortion debate, we have created a metaphysical category — “identity” — in order to avoid talking about physical reality. In the case of sex-reassignment surgery, it is gender identity; in the case of those who want their left legs removed, it is body-integrity identity. The latter may seem shocking and exotic, but the former is no more defensible. But the question of sex reassignment is linked rhetorically and politically to the question of gay rights, though homosexuality is an entirely distinct and separate phenomenon under the emotional shadow of civil rights. It is a measure of the intellectual degradation of our times that the physical reality of these cases is considered, if it is considered at all, a distant second to the subjective impressions of people who are, not to put too fine a point on it, mentally ill and in need of treatment.
We cannot think because we cannot speak. Having lost the words for things, we lose the things themselves. The word “gender” as a replacement for the word “sex” is a new development in the English language, dating from the early 1960s, not coincidentally the period during which the normalization of sex reassignment began to gain real momentum. “Gender” is a linguistic twin of the word “genre,” the two descending in parallel from the Latin “genus” via the Old French “gendre.” This was partly the natural evolution of the language — as the word “sex” began to denote erotic acts themselves, there was an opening for a word to describe the categorical differences between the male and the female. But it is not an accident that a literary term received the promotion over a scientific one: “Gender” overtook “sex” linguistically at the same time that “gender,” which denotes male–female differences that are, in the debased language of the time, “socially constructed,” overtook “sex,” which denotes male–female differences that are biological, as a guiding consideration. Every battle in the war on reality begins with the opening of a new linguistic front.
That leaves us in the unhappy position described by Dr. McHugh: “The zeal for this sex-change surgery — perhaps, with the exception of frontal lobotomy, the most radical therapy ever encouraged by twentieth-century psychiatrists — did not derive from critical reasoning or thoughtful assessments . . . [but from] the ‘illusion of technique,’ which assumes that the body is like a suit of clothes to be hemmed and stitched to style.” And not just the body: The family and society are as much the products of evolution as the body is, and attempting to reconstruct them in the image of the Venus de Milo — arms optional — with contempt for the underlying reality will yield ghastly results.