When a man wants to be a woman, or a woman a man, is it because nature gave them the wrong body? Or did something else go wrong?
The idea that a person's sex is a mere biological accident that can be
changed to suit one's chosen gender has wide currency today. But,
according to psychiatrist Richard Fitzgibbons, this intellectual fad is
not at all helpful to people who are genuinely confused about their
Dr Fitzgibbons, who has nearly 30 years' clinical experience behind
him, is the director of a private practice outside Philadelphia and
leads the team of the Institute for Marital Healing. He has made a specialty of forgiveness therapy in the resolution of excessive anger, and has co-authored a book on the subject with Robert D. Enright, published by the American Psychological Association.
In this interview with MercatorNet he explains why a sex-change operation is not the answer to gender identity problems.
MercatorNet: Are there people who are genuinely confused about their sexual identity—whether they are male or female?
Rick Fitzgibbons: Yes, there are people who are confused due to
the seriousness of their emotional pain and conflicts which interfere
with cognitive functioning. Many of these individuals have failed to
embrace the goodness and beauty of their masculinity or femininity in
childhood and in adolescence for numerous reasons.
Unless treated properly, they may go on to hate their masculinity and
femininity. Their sadness and lack of acceptance by peers or a parent
can lead them to believe that they may be able to escape from their
emotional pain and find greater happiness, acceptance and confidence
being of the opposite sex.
MercatorNet: It is possible to have a female person "inside" a male body, and vice versa?
Fitzgibbons: No, it is not. A person may feel this way because
of emotionally painful experiences primarily with those of the same
sex. Initially, they fantasise living as someone of the opposite sex in
an attempt to escape from their pain. An excessive fantasy life then
can lead to cross-dressing, to a greater identification with the
opposite sex and even to a delusional belief that one is of the
MercatorNet: Can a person's sex be changed — surgically or in any way?
Fitzgibbons: No, each cell of a person's body contains
chromosomes which identify that individual as either male or female. It
is not simply a question of different genitals. Before birth prenatal
hormones shape the brains of boys to be different from those of girls.
Mutilating surgery and hormone treatments can create the appearance of
a male or female body, but it cannot change the underlying reality. It
is not possible to change a person's sex.
MercatorNet: What do follow-up studies show in regard to sex-change surgery?
Fitzgibbons: Dr Paul McHugh reported in an article in First Things
that when he was the psychiatrist-in-chief at Johns Hopkins, he studied
the outcomes of such surgeries. The study found that while most of the
clients said they were happy with the outcome, the various
psychological problems which accompanied their feeling that they were the
other sex remained unchanged. They still had the same difficulties with
relationships, work and emotions. Dr McHugh concluded that "to provide a surgical alteration to the body
of these unfortunate people was to collaborate with a mental disorder
rather than to treat it."
MercatorNet: What are the reasons why people seek to change their sex?
Fitzgibbons: The most common causes are a lack of acceptance and
rejection in childhood and adolescence by peers and by the parent of
the same sex, deep resentment toward these individuals, hatred of their
bodies, intense fears of being betrayed and hurt, and a deep desire to
be protected in the world. Less common causes are rejection by the
parent of the opposite sex and the belief that if they were of the
opposite sex they would receive the warmth and love from that parent
which they did not receive as children.
A less common conflict is seen in some boys and men who have powerful
artistic and creative gifts, which lead them to experience a strong
attraction to the beauty in the female world and to an identification
with femininity. This artistic response can begin early in childhood
and can lead to a desire to be female. In rare cases, a parent wants a
child to be of the opposite sex and dresses and treats the child as being
of the opposite sex.
Finally, many of those who seek surgical “sex change” suffered from
undiagnosed and untreated gender identity disorder (GID) as children.
MercatorNet: Can these emotional conflicts be successfully treated?
Does the desire for sex-change surgery change after such treatment?
Fitzgibbons: Yes, it is important not to take the desire for sex
change surgery at face value, but to uncover the emotional conflict
which has led people to think they would be happier or safer as the
other sex. The recognition of emotional pain with peers or with a
parent leads to the awareness of significant anger which can be
resolved through a process of forgiveness. At the same time it is
necessary to treat poor body image, low self-esteem, sadness and fears.
As with the treatment of substance abuse disorders, spirituality can
play an important role in the healing process. We regularly recommend
that Catholic patients work with a spiritual director. Also, in those
with faith a major goal of treatment is to help individuals to see
accept their unique masculinity and femininity as a positive gift from
As the emotional conflicts are treated effectively the appreciation for
one's unique and special personhood increases. Subsequently, the desire
for sex change surgery is resolved.
MercatorNet: How can parents identify gender identity disorder? Can it be successfully treated in childhood?
Fitzgibbons: Gender identity symptoms include strong cross gender
identification, exclusive cross-gender play, a lack of same-sex friends
and cross-dressing. Children with these symptoms should be treated as
though something may be very wrong (link to my GID article at
www.narth.com). Parents and paediatricians should not minimize or
overlook these serious symptoms.
The psychiatric literature clearly demonstrates that children with GID
can be successfully treated if both parents cooperate in the solution,
especially fathers. According to Dr Kenneth Zucker and Susan Bradley,
experts in the treatment of gender identity problems in children,
treatment should begin as soon as possible. I have an article on this subject on the website of the National Association for Research & Therapy of Homosexuality.
MercatorNet: Last year the Guardian newspaper in Britain
commissioned a review of more than 100 international studies of
post-operative transsexuals, after interviewing people who regretted
having such surgery, and this research found no robust evidence that
the surgery is clinically effective. Why do some scientists insist,
even against the evidence, that sex can be changed? What is the bigger
issue at stake here?
Fitzgibbons: In spite of the scientific research, the support for
the idea of "sex change" operations has continued to grow. In fact,
there have been several articles discussing whether it is advisable to
begin the "sex change" process in adolescence or even before.
I have personally had the clinical experience recently where a troubled
mother found support from two child psychiatrists at different major
East Coast university medical centres to begin transitioning her
nine-year-old son to a female. Fortunately, the judicial system blocked
this medical recommendation, warned the mother and gave primary custody
of this boy to his father.
Dr Paul McHugh, whom I referred to earlier, has summed up the
philosophy behind this mindset well: "One might expect that those who
claim that sexual identity has no biological or physical basis would
bring forth more evidence to persuade others. But as I've learned,
there is a deep prejudice in favor of the idea that nature is totally
malleable. Without any fixed position on what is given in human nature, any
manipulation of it can be defended as legitimate. A practice that
appears to give people what they want — and what some of them are
prepared to clamour for — turns out to be difficult to combat with
ordinary professional experience and wisdom. Even controlled trials or
careful follow-up studies to ensure that the practice itself is not
damaging are often resisted and the results rejected."
People are coming to believe that they can create, use, change and destroy life as they so choose.
Carolyn Moynihan is deputy editor of MercatorNet.